TMS vs. Neurofeedback: Understanding the Difference

When it comes to non-medication treatments for mental health, two approaches people often hear about are Transcranial Magnetic Stimulation (TMS) and Neurofeedback. They sound similar, but they work in very different ways. Here’s a clear breakdown.

What is TMS?

• How it works: TMS uses gentle magnetic pulses to stimulate a part of the brain linked to mood (the dorsolateral prefrontal cortex).

• FDA-cleared uses: In the U.S., TMS is cleared for major depressive disorder, obsessive-compulsive disorder (with certain devices), migraine (single-pulse TMS), and smoking cessation (deep TMS).

• Treatment course: Usually 5 days a week for 4–6 weeks. Sessions last about 20–40 minutes, and you can go back to normal activities right after.

• Evidence: Backed by multiple large studies showing benefit for treatment-resistant depression.

• Side effects: Most often mild scalp discomfort or headache; very rarely, a seizure.

What is Neurofeedback?

• How it works: Neurofeedback (also called EEG biofeedback) uses sensors on the scalp to measure brainwaves. Patients get real-time feedback (like a game or video that changes with brain activity) and practice shifting their brainwave patterns.

• FDA status: Classified as a biofeedback device in the U.S. This means it can be marketed for general training and self-regulation, but it does not carry the same disease-specific FDA clearances as TMS.

• Treatment course: Usually 1–2 sessions per week over several months. Progress depends on active participation.

• Evidence: Research is ongoing. Some studies suggest possible benefit for ADHD, anxiety, or sleep, but results are mixed and less consistent than TMS for depression.

• Side effects: Generally mild (fatigue, headache) and uncommon.

Key Differences at a Glance

What it is:TMS works by using gentle magnetic stimulation to directly influence brain activity, while neurofeedback is a form of brainwave training where patients learn to adjust their own brain activity with feedback.

Patient role:With TMS, the treatment is passive — the device does the work while the patient simply sits through the session. With neurofeedback, the treatment is active — the patient practices and learns how to change their brain activity in real time.

FDA status:TMS has FDA clearance for specific conditions including depression, OCD (with certain devices), migraine, and smoking cessation. Neurofeedback devices are classified as general biofeedback tools and are not FDA-cleared for treating specific mental health disorders.

Evidence for depression:TMS has strong support from multiple large clinical studies showing effectiveness for treatment-resistant depression. Neurofeedback research for depression is still developing, with mixed results so far.

Time commitment: TMS usually involves daily sessions, five days a week, for four to six weeks. Neurofeedback is generally done once or twice a week over several months.

Which is Right for You?

• If you have treatment-resistant depression, TMS has stronger clinical evidence and established insurance coverage.

• If you’re curious about training your own brain activity, or exploring ADHD or anxiety support, neurofeedback may be an option—just know that results can vary and it’s not FDA-cleared for specific conditions.

The Bottom Line

Both TMS and neurofeedback are non-invasive and drug-free. The main difference is that TMS stimulates the brain directly, while neurofeedback trains you to change your brain activity yourself.

At Goodwin Health Café, we focus on evidence-based treatments like TMS for depression. If you’re considering your options, our team can walk you through what’s available and help you make an informed choice.

Goodwin Health CaféTreatment-Resistant Depression Care 5625 N. Wall St. Suite 100 Spokane, WA 99205, USA