Life After TMS: Maintenance, Relapse Prevention, and Staying Well

Getting well and staying well are two different problems. A course of TMS that isn't followed by a maintenance plan gives up much of what it earned — and depression has a real relapse rate that no honest clinician can wave away. This is the part of the conversation that too often gets left out of the marketing.

Here's the plan we build with every patient who responds to treatment — starting the day the acute course ends.

Weeks 1 through 4: the follow-up window

Your last day in the chair is not the day we stop paying attention. In the first four weeks after treatment finishes, we track your symptoms every week using a short remote questionnaire. No visits required, no additional TMS sessions.

This window matters because improvement is often still building. In studies of accelerated schedules, many patients who saw little change by the last treatment day went on to improve substantially over the next two to four weeks. Tracking you weekly is how we catch that late improvement instead of missing it — and how we distinguish a slow-but-real response from a genuine non-response.

The four-week checkpoint

At week four we look at where you actually stand. There are three possibilities, and each has a defined next step.

Remission — symptoms minimal or gone

You move directly onto the maintenance schedule below, designed to protect what you've gained.

Response — substantially better, not all the way

You begin maintenance, and we discuss whether additional sessions or an adjustment to your other treatment would close the remaining gap.

Limited response — little or no change

We reassess together. Options include a different stimulation approach, a change in targeting, or another treatment path altogether. This is why baseline measurement and rigorous follow-up matter — decisions are based on data, not guesses.

Months 1 through 6: weekly maintenance

For patients who responded, we schedule one maintenance session per week — about six minutes in the chair. Weekly maintenance during the first six months lowers the risk of relapse to roughly 18% over that window, which is substantially better than the natural course of treated depression without any maintenance plan.

Months 7 through 12: every other week

If you've stayed well through the first six months, we step the schedule down to one session every two weeks. The goal is to give your brain the reinforcement it needs while progressively returning your calendar to you.

After 12 months: a trial off-schedule

At the one-year mark, we typically move to a trial period with no maintenance sessions and monthly remote check-ins for six months. The goal is for you to hold your gains on your own. Many patients do — and the ones who need occasional reinforcement now have a template for what that looks like.

If symptoms come back: the rescue course

A return of symptoms is not a failure, and it does not mean starting over. A short rescue course of daily sessions — usually five to ten treatment days — restores improvement in roughly 69% of cases. You do not repeat the full acute program.

The single most important thing patients can do here: tell us early. Rescue treatment works better the sooner it starts. Waiting until symptoms are entrenched again is the mistake we most want to help you avoid.

How to get the most out of the maintenance year

• Continue all prescribed medications. Don't stop or change anything on your own — and tell us if another clinician changes your regimen.
• Protect your sleep. It matters more than most patients expect, both during acute treatment and afterward.
• Go easy on alcohol. Heavy use interferes with the brain changes TMS is working to sustain.
• Tell us about changes. New symptoms, new health problems, new prescriptions from another doctor — we need to know.
• Otherwise, live normally. There are no dietary restrictions and no activity limitations.

Why a real maintenance plan is not optional

It's tempting, after a successful acute course, to treat the finish line as the finish line. Understandable — but not clinically honest. Depression is a condition that leans toward recurrence, and the entire point of a boutique concierge practice is that follow-through doesn't fall through the cracks. Your maintenance year is where the gains of the acute course are either protected or slowly given back.

If you're considering accelerated TMS, ask any practice you're evaluating what their follow-up window and maintenance schedule actually look like. The answer tells you a lot about how they think about your outcome — not just their throughput.

Dr. Raena Khorram is a board-certified psychiatrist and founder of Bryn Mawr Mental Health and Wellness, a boutique interventional psychiatry practice on the Main Line.