TMS. Why aren’t more people using this method to treat depression? Transcranial Magnetic Stimulation (rTMS) is becoming increasingly recognised as a valid, non-invasive option for people with depression. It is particularly worthwhile if the person has not responded adequately to medications and other therapy. Evidence continues to mount for its’ efficacy: for instance, a recent consensus review notes remission rates as high as 62% in treatment-resistant depression. Yet despite this, uptake remains modest in Australia. There are several interlocking reasons why more people are not trying it. Some reasons may include cost, access, awareness, time commitment, stigma, and clinical practice inertia.
Key Barriers to TMS
- Cost and Insurance / Funding Issues
One of the biggest obstacles is financial. TMS can be expensive. Out-of-pocket costs can be expensive. Many patients and clinicians may see this as a financially risky option. For those who are looking at TMS for the first time will be pleased to know that Medicare is providing a rebate providing the patient can meet their criteria for TMS. TMS cost information. - Limited Access / Geographic Barriers
TMS requires specialised equipment in clinics, trained staff, and typically many sessions in person. For people living in rural areas, or regions with few clinics offering TMS, travel time and availability are serious burdens. Likewise, clinic hours may not suit people who work standard business hours. - Time Commitment and Treatment Burden
Standard treatment protocols often require daily sessions, with a minimum of 3 session per week over several weeks. This means attending a clinic regularly, which can be challenging for people with work, family, mobility, or mental health limitations (e.g. depression reduces energy, motivation, can heighten anxiety about going out). The burden of consistent attendance is a major deterrent - Awareness and Knowledge Gaps (Patients and Providers)
Many people (including both patients and doctors) simply don’t know much about TMS. Including; How TMS works? How effective TMS is. What side effects TMS may have? How many people respond? How long effects last? Similarly, some clinicians may not be familiar enough, or may delay referring to TMS, either because they are not updated on latest evidence or due to practice culture. - Stigma, Misconceptions, and Fear
Mental health treatments already carry stigma, and some treatments may provoke fear (e.g. confusion with Electroconvulsive Therapy, concern about side effects, or perception of “experimental” treatment). Some potential patients worry about what TMS involves, whether it’s safe, or whether it will help. Also fear of “trying something new” or more intense because previous treatments failed. - Variability of Outcomes & Uncertainty
Though many respond to the treatment, not everyone does. The variability in response, remission, maintenance, and how long benefits last can make both patients and providers cautious. If someone has already gone through multiple treatments without success, the risk of “this one might not work either” can discourage trying TMS. - Clinical Practice Inertia and Guidelines / Referral Patterns
Even with strong evidence, treatment patterns often lag. Many clinicians follow traditional algorithms, which prioritise medications and psychotherapy first. Referral pathways to TMS may not be well established and are therefore not considered.
With all that said there are many reasons why people with Major Depression should consider this treatment, particularly if other treatment options have failed to reduce symptoms.
The following references were sourced for this article and deserve to be credited.
NeuroMod Health+2BioMed Central+2
SpringerLink+3SpringerLink+3BioMed Central+3
BioMed Central+2SpringerLink+2
ScienceDirect+3SpringerLink+3BioMed Central+3
BioMed Central+3BioMed Central+3SpringerLink+3
ScienceDirect+2BioMed Central+2
BioMed Central+2ScienceDirect+2
Posted: 1 October 2025
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