If you’ve been researching TMS therapy, you may have seen clinics talk about brain scans, functional MRI or MRI-guided treatment. That can make it seem like detailed brain imaging is required before every TMS treatment.
It isn’t.
At Resiliency Mind + Body Medicine, we use BrainsWay Deep TMS, which allows us to treat the brain networks involved in depression without requiring an fMRI first.
That decision reflects how we understand depression. We don’t view it as something “hiding” in one tiny spot in the brain. Instead, we see depression as involving a network of connected brain regions. BrainsWay’s H-Coil is designed to stimulate those networks more broadly, making pinpoint targeting less critical than it is with smaller, more focused coils.
Explore a simpler path to Deep TMS with a personalized evaluation at Resiliency Mind + Body Medicine.
The Basics
- Functional MRI is not required for every TMS treatment.
- Many clinics use scalp measurements to locate treatment targets.
- The 10-20 EEG system is another established MRI-free targeting method.
- MRI-guided TMS can provide more individualized targeting.
- BrainsWay Deep TMS uses a broader H-Coil treatment field.
- Treatment settings are still personalized without an fMRI.
Why Do Some TMS Clinics Use Brain Imaging?
TMS uses magnetic pulses to stimulate nerve cells in brain regions involved in mood regulation. For major depressive disorder, one common target is the left dorsolateral prefrontal cortex, or DLPFC.
Some clinics use a structural MRI or functional MRI with neuronavigation to help locate this treatment target. MRI-guided TMS can provide greater anatomical precision and allow clinicians to account for differences in individual brain structure.
That can be useful, but it’s not the only accepted way to deliver TMS.
How Can TMS Be Targeted Without an fMRI?
TMS doesn’t always require a brain scan to find the right treatment area.
Many clinics use measurements taken from the scalp and head to guide where the TMS coil should be placed. These methods have been used for years and remain established approaches in clinical practice.
A recent expert consensus review on TMS for depression notes that scalp-based methods are widely used for targeting treatment. It also found that while MRI-based neuronavigation can improve positioning accuracy, structural MRI guidance alone has not consistently been shown to improve treatment outcomes.
The clinical team also measures your individual motor threshold before treatment begins. This helps determine the appropriate stimulation level for you without relying on an MRI.
How Does BrainsWay Deep TMS Work Without an fMRI?
BrainsWay Deep TMS uses an H-Coil contained inside a helmet rather than a smaller figure-eight magnetic coil.
This difference is one of the main reasons Resiliency chose BrainsWay.
The H-Coil is designed to stimulate a broader and deeper area of the brain. Instead of depending on one tiny target, it reaches a larger neural network involved in depression. Because the stimulation field is broader, small differences in positioning are less likely to mean the intended treatment area is missed.
For us, that means we can provide effective, individualized TMS without asking patients to schedule and pay for an additional functional MRI simply to begin treatment.
That aligns with another important Resiliency value: accessibility. If we can remove an unnecessary step without compromising the quality of care, we believe that creates a better patient experience.
Is TMS Still Personalized Without Brain Imaging?
Absolutely.
Before treatment begins, the clinical team reviews your:
- Diagnosis and symptoms
- Previous antidepressant trials
- Current medications
- Medical and neurological history
- Previous depression treatments
- Potential safety concerns
Your provider also determines your motor threshold, which helps establish the amount of stimulation needed during treatment. Motor threshold calibration relies on a physical response to magnetic stimulation rather than an MRI.
The clinical team then establishes the appropriate treatment position and monitors your symptoms throughout the full treatment course.
Are TMS Side Effects Different Without an fMRI?
Using or skipping functional MRI doesn’t fundamentally change the usual side effects of TMS.
Common side effects include headache and scalp discomfort, and some patients may experience temporary treatment-related anxiety. These effects are generally mild and tend to resolve quickly.
TMS also avoids several side effects associated with some other depression treatments, such as weight gain or sexual dysfunction.
Your individual risks should still be reviewed before treatment, particularly if you have a history of seizures, traumatic brain injury, certain implanted metal devices, or other medical considerations.
Does More Precise Targeting Mean Better Results?
MRI and fMRI guidance can improve the precision of TMS targeting, and ongoing research is exploring whether individualized brain mapping can improve outcomes.
However, conventional MRI-free targeting methods also have a long history of clinical effectiveness in treating major depression. TMS has been FDA-authorized for depression since 2008, and many clinical studies have used targeting methods that do not require functional imaging.
The right approach depends on the TMS technology, treatment protocol, diagnosis, and clinical team.
Can You Get TMS Without Functional MRI?
Yes. Functional MRI is one tool for guiding brain stimulation, but it is not a universal requirement for TMS therapy.
At Resiliency Mind + Body Medicine, BrainsWay Deep TMS allows us to combine broad H-Coil stimulation with individualized motor-threshold calibration, physician-led evaluation and ongoing symptom monitoring.
For patients, that can mean one less appointment, one less expense and one less hurdle between deciding to seek treatment and actually receiving it.
Just as importantly, the process still reflects Resiliency’s broader approach: advanced treatment paired with professional, accessible and genuinely patient-centered care.
Ready to learn whether Deep TMS could fit your treatment plan? Contact Resiliency Mind + Body Medicine to schedule a consultation.