Depression is one of the most prevalent mental health conditions worldwide and is associated with high levels of impairment with daily functioning at work, school, and relationships with family and friends. While depression can be well managed with psychotherapy, medication, or both, these first-line treatments may not always provide enough relief. Despite receiving treatment, some individuals may experience little to no improvement in their symptoms or continue to experience symptoms that interfere with daily life. These patients are considered to have treatment-resistant depression.

Transcranial Magnetic Stimulation (TMS) is an FDA approved, safe, and non-invasive intervention for individuals with treatment-resistant depression. TMS is a form of brain stimulation that targets areas of the brain that help regulate mood with the goal of improving depressive symptoms. TMS is well-tolerated with most reported side effects, such as scalp discomfort and headaches, being mild and short-lived. For people who continue to experience depression despite prior treatment, TMS provides another option to help reduce depressive symptoms and help people get back to daily functioning.

LifeStance is well poised to provide treatment options for those seeking further care for their depression. By expanding TMS services from 11 to 22 states by the end of 2026, LifeStance is helping more patients access evidence-based care closer to home. LifeStance has built one of the nation’s largest networks of outpatient TMS clinics, supported by more than 75 highly trained TMS psychiatrists who work alongside therapists and psychiatric clinicians. To date, these clinicians have helped more than 1,100 individuals explore an additional path toward recovery when medications and psychotherapy have not provided sufficient relief.

Many Patients Experienced Meaningful Improvement

To better understand patient outcomes in clinical practice, LifeStance examined changes in the Patient Health Questionnaire (PHQ-9) scores among patients treated with TMS between Jan. 1, 2025 and May 31, 2026. This included patients who had a depression diagnosis, completed a PHQ-9 assessment within 30 days before beginning TMS, and received a treatment course consisting of at least 30 sessions, which is the recommended minimum number of sessions for depression-related treatment.1 The PHQ-9 is a validated, nine-item questionnaire that assesses the severity of depressive symptoms and monitors changes over time.2 Scores range from 0 to 27 with higher scores indicating more severe depression symptoms.

A total of 355 patients aged 17 to 80 (mean age of 43 years), initiated TMS treatment with at least moderate depressive symptoms. Patients identified as 54% female, 30% male, and 5% transgender/nonbinary/genderqueer (with 11% missing gender data or declining to provide) and began their TMS treatment with at least moderate depressive symptoms. Of these patients, 61% experienced a clinically meaningful reduction in depression severity*. These findings highlight the effectiveness of TMS in real-world outpatient practice and its potential to improve outcomes for individuals with treatment-resistant depression.

Consistent Improvement Among Patients with More Severe Symptoms

LifeStance further examined outcomes among 258 patients with treatment-resistant depression who presented with more severe depressive symptoms. These patients initiated TMS treatment with PHQ-9 scores of 15 or greater, indicating moderately severe to severe depressive symptoms. Patients had a depression diagnosis, completed a PHQ-9 within 30 days before treatment, and received at least 30 TMS sessions. Ages ranged from 17 to 77, with a mean age of 41 years. Patients identified as 53% female, 26% male, and 6% transgender/nonbinary/genderqueer (with 13% missing data or declining to provide).

Prior to treatment initiation, the average PHQ-9 score was 19.67, reflecting substantial depressive symptom burden. Following treatment completion, the average PHQ-9 score decreased to 11.90. This change represents an average reduction of 7.77 points, or a 39% reduction in depressive symptoms over the course of treatment. In addition, 65% of patients achieved clinically meaningful improvements* in their depressive symptoms.

Notable Improvement in Suicidal Ideation

Suicidal ideation, which refers to thoughts of hurting or killing oneself, is a serious symptom of depression. Further evaluation of the PHQ-9 was conducted to determine how suicidal ideation was impacted among the 355 patients with diagnosed depression who completed 30 sessions or more of TMS. Prior to treatment, 52% reported no suicidal ideation. Following the completion of TMS treatment, patients experienced marked reductions in suicidal ideation, with 72% of patients reporting they did not experience any suicidal ideation (see Table 1 below).

Similarly, patients who reported experiencing suicidal ideation nearly every day decreased by over 50% post TMS treatment.

Given the serious clinical implications of suicidal ideation, these results provide compelling evidence of the potential of TMS to positively impact patient safety and well-being.

Table 1. PHQ-9 Question 9 Responses on Suicidal Ideation Before and After TMS treatment

Response Before TMS After TMS Change in Patient %
Nearly every day 13% 6% 50% reduction in patients reporting suicidal ideation nearly every day
Not at all 52% 72% 38% increase in patients reporting no suicidal ideation

Supporting More Paths Toward Better Mental Health

Taken together, these findings highlight that TMS can provide meaningful clinical benefit for those who have not experienced adequate relief with first-line treatment approaches. For patients with treatment-resistant depression, TMS represents an important evidence-based option that may help address significant unmet mental health needs. The observed reduction in depressive symptoms, including improvements among those experiencing suicidal ideation, underscore the potential of TMS to provide relief for individuals facing some of the most challenging and persistent forms of depression.

Notably, these outcomes were achieved in outpatient clinical practice rather than within the highly controlled setting of a clinical trial. This real-world evidence highlights the ability of TMS to deliver meaningful and measurable improvements across diverse patient populations and everyday care environments.

Depression is a complex and serious condition. Expanding access to a broad range of evidence-based treatment options is essential to improving outcomes. By making TMS available across a growing outpatient network, LifeStance is increasing access to innovative, noninvasive treatments for treatment-resistant depression and creating new opportunities for patients to achieve meaningful recovery, improved functioning, and better quality of life.

* Clinically meaningful improvement is defined as PHQ-9 severity score reduction of five or more points

Citations

  1. Hutton, T. M., Aaronson, S. T., Carpenter, L. L., Pages, K., Krantz, D., Lucas, L., Chen, B., & Sackeim, H. A. (2023). Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry. Brain Stimulation, 16(5), 1510–1521. https://doi.org/10.1016/j.brs.2023.10.001

  2. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

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Authored By 

Stephanie Eken, MD, MBA

Stephanie Eken, MD, MBA, is a triple board-certified psychiatrist, child and adolescent psychiatrist, and pediatrician with more than 20 years of experience in behavioral health, currently serving as Chief Medical Officer at LifeStance, where she leads clinical strategy and vision...

Authored By Jennifer Park, PhD
Jennifer Park, PhD

Jennifer Park, PhD, is a licensed clinical psychologist, behavioral health executive, and expert in cognitive behavioral therapy (CBT). She serves as Vice President of Clinical Excellence & Innovation at LifeStance Health and is an Adjunct Clinical Associate Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. In her leadership role, she advances clinical quality, measurement-based care, and innovation across one of the nation's largest outpatient behavioral health organizations. Prior to joining LifeStance, Dr. Park served as Vice President of Clinical Services at Acadia Healthcare, where she oversaw clinical services across inpatient psychiatric hospitals, residential treatment centers, and substance use disorder treatment programs. Previously, as Executive Director of Outpatient Services at Rogers Behavioral Health, she led clinical services for partial hospitalization and intensive outpatient programs. Across these roles, she has extensive experience translating empirically supported treatments into scalable, sustainable models of care within large healthcare systems. Dr. Park earned her PhD in Clinical Psychology from the University of South Florida and completed her internship and fellowship training at Massachusetts General Hospital/Harvard Medical School. She has authored numerous publications and delivered more than 100 presentations at national, regional, and local professional forums on evidence-based care, implementation science, and behavioral health innovation.

Authored By Stephen Fleming, MD
Stephen Fleming, MD

Dr. Stephen Fleming is a psychiatrist who has been practicing since 2012. He obtained his bachelor's degree at the University of Georgia and his medical school education at the Medical College of Georgia in Augusta, GA. He received training in general psychiatry as well as child and adolescent psychiatry at the Medical College of Georgia while completing his residency and fellowship.Dr. Fleming seeks to utilize his clinical expertise to help those who are struggling with mental illness not only treat their illness to remission but also achieve the sense of well-being and fullness of life they desire. Since 2018 he has been a prescriber of Transcranial Magnetic Stimulation, a non-invasive magnetic therapy approved for the treatment of depression and OCD.In his time away from the office, Dr. Fleming enjoys spending time with his family and his dogs, exercising, reading, watching sports--in particular the Georgia Bulldogs, and traveling.

Authored By Olga Konovalova, Master’s in Finance
Olga Konovalova, Master’s in Finance

As part of the Insights and Analytics team, Olga designs scalable data models and business intelligence solutions that transform complex clinical and operational data into clear, actionable insights to support decision-making across clinical and leadership teams. With a focus on clinical quality and patient outcomes, Olga is passionate about using data to drive meaningful improvements in healthcare delivery.

Authored By Bridget Balkaran, MPH
Bridget Balkaran, MPH

A driven biostatistician with strong analytical skills for EMR data. Focuses on translating statistical results into interpretable solutions by identifying and reporting associations. Experience with machine learning and regression models. A unique combination of technical proficiency and clear communication through storytelling with data to discover solutions.