PTSD symptoms can remain significant after treatment with psychotherapy, medication, or both. Research on rTMS for PTSD is active, but results have varied across studies and protocols. At The Mind Grove TMS Center in Colorado Springs, we offer rTMS for PTSD on an off-label basis. A separate TMS system, the MeRT System, received FDA clearance in 2026 as an adjunct treatment for adults with PTSD; that clearance does not apply to the rTMS protocols we currently use for PTSD at The Mind Grove (U.S. Food and Drug Administration, 2026). Here, we explain where the research stands, what off-label treatment means at our practice, and what patients should know before considering TMS for PTSD.
What Is PTSD?
Post-traumatic stress disorder can develop after experiencing, witnessing, or learning about an event involving actual or threatened death, serious injury, or sexual violence. Symptoms are generally grouped into four areas: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions (Mayo Clinic, 2024). Symptoms can persist and interfere significantly with daily functioning and relationships.
Evidence-based treatment for PTSD includes trauma-focused psychotherapies such as Trauma-Focused Cognitive Behavioral Therapy, Cognitive Processing Therapy, and EMDR. The 2023 VA/DoD guideline also recommends sertraline, paroxetine, or venlafaxine as medication options for PTSD (Schnurr et al., 2024). At The Mind Grove TMS Center, medication can remain part of care when clinically appropriate. We do not treat TMS as a replacement for evidence-based psychotherapy or medication.
PTSD affects veterans, active-duty service members, first responders, and civilians. TMS research includes military and veteran populations, but results from one patient group or treatment protocol do not necessarily apply to every person with PTSD.
What Off-Label Means for Treatment of PTSD
The FDA cleared the MeRT System in 2026 as an adjunct treatment for adults with PTSD (U.S. Food and Drug Administration, 2026). That clearance is specific to the MeRT System and does not make every TMS protocol FDA-cleared for PTSD. The rTMS protocols we currently use for PTSD at The Mind Grove TMS Center are currently off-label. Off-label prescribing and treatment are established parts of medical practice, but the distinction matters when we discuss the evidence, treatment planning, and insurance coverage.
Our off-label rTMS treatment for PTSD is generally not covered by insurance. We discuss cost with patients before treatment begins so that the financial expectations are clear. We also explain the difference between the protocol we use at Mind Grove and the separate MeRT protocol that now carries an FDA-cleared adult PTSD indication.
Where the Research Stands
Research on rTMS for PTSD has examined different stimulation targets, frequencies, treatment schedules, and patient populations. Results have not been uniform, and we do not describe PTSD as a disorder of one brain region or assume that one TMS protocol applies across every patient or study.
Individual sham-controlled, randomized controlled trials have demonstrated improvement in PTSD symptoms after rTMS treatment, and that augmenting psychotherapy with TMS yields greater improvements than psychotherapy alone (Boggio et al 2010, Kozel et al 2018, Leong et al 2020, Yuan et al 2023). However, recent reviews have reached contrasting conclusions. A 2024 Cochrane review of 13 randomized controlled trials involving 577 participants found that active rTMS probably made little to no difference in PTSD severity immediately after treatment compared with sham stimulation in its primary analysis, while also finding substantial variation across studies and protocols (Brown et al., 2024). On the other hand, a 2025 meta-analysis of 15 studies involving 760 patients found improvement in PTSD symptoms with rTMS but also noted small sample sizes, substantial heterogeneity, and limits on how broadly the findings can be applied (Wang et al., 2025). Interestingly, a more recent retrospective, propensity matched cohort study comparing 10 Hz rTMS, iTBS and dTMS showed that all three treatment protocols led to a significant reduction in PTSD symptoms, and that no protocol or device was superior to the other two (Berlow et. al 2026).A 2026 systematic review and meta-analysis focused on combat-related PTSD found that TMS was generally well tolerated across the included studies. Reported adverse effects were predominantly mild and included transient headache, scalp discomfort, and fatigue; no serious adverse events were reported in the included studies (Virto-Farfan et al., 2026).
The 2023 VA/DoD clinical practice guideline found insufficient evidence to recommend for or against rTMS for PTSD because the available evidence was mixed and methodologically limited (Schnurr et al., 2024). That guideline predates the 2026 FDA clearance of the MeRT Syste, and the more recent meta-analyses and individual studies showing symptom improvement in response to TMS.
Taken together, the current evidence supports TMS as a potential treatment for PTSD, while acknowledging that more research is needed for definitive conclusions.
Who Should Consider TMS for PTSD
We may consider off-label rTMS for adults with PTSD whose symptoms remain significant despite prior treatment. TMS may be used alongside medication management when clinically appropriate, and we encourage patients to continue working with their existing therapy providers when psychotherapy is part of their care. Because our PTSD protocol is generally not covered by insurance, we also discuss cost before treatment begins.
Before treatment begins, we review your diagnosis, trauma and treatment history, current medications, safety considerations, and current care plan to determine whether rTMS is appropriate. We also discuss what the available evidence can and cannot tell us about expected response. Results vary by individual.
What to Expect
Treatment is provided in our Colorado Springs office while you are seated and awake, and TMS does not require anesthesia or sedation. Because our use of rTMS for PTSD is off-label and the research includes different treatment protocols, we discuss the proposed protocol, treatment schedule, monitoring plan, and expected cost during your evaluation rather than applying one response timeline to every patient.
FAQ
Is TMS approved for PTSD?
A specific TMS system now carries FDA clearance for PTSD. In 2026, the FDA cleared the MeRT System as an adjunct treatment for adults with PTSD (U.S. Food and Drug Administration, 2026). That clearance does not apply to every form of TMS. At The Mind Grove TMS Center, the rTMS protocols we currently use for PTSD are currently off-label.
Will insurance cover TMS for PTSD?
Our off-label rTMS treatment for PTSD is generally not covered by insurance. Colorado Medicaid does not cover TMS. We review cost with patients before treatment begins so there are no assumptions about coverage.
I’m a veteran with PTSD. Is TMS an option for me?
Possibly. We evaluate veterans individually based on diagnosis, prior treatment, current medications, safety considerations, and the overall care plan. TMS research includes veteran and military populations, although the evidence remains mixed. Our current rTMS treatment for PTSD remains off-label.
How is TMS for PTSD different from TMS for depression?
The diagnoses, evidence bases, treatment protocols, and FDA indications are different. We offer FDA-cleared TMS treatment for qualifying depression-related indications, while the rTMS protocols we currently use for PTSD are off-label. A separate system, the MeRT System, now carries an FDA-cleared indication for adult PTSD. We evaluate each condition and treatment plan separately rather than assuming that a protocol used for depression applies to PTSD.
What happens if TMS doesn’t help my PTSD?
Not every patient responds to TMS. If your symptoms do not improve as expected, we reassess your response and the overall treatment plan. Medication management can remain part of care when clinically appropriate, and we can coordinate with other members of your care team when needed. Before treatment begins, we discuss the limits of the evidence so that expectations are clear.
Key Takeaways
We offer rTMS for PTSD on an off-label basis at The Mind Grove TMS Center.
The MeRT protocol, which combines TMS with EEG,, received FDA clearance in 2026 as an adjunct treatment for adults with PTSD; that clearance does not apply to the rTMS protocols we currently use for PTSD.
Research on rTMS for PTSD is mixed, with differences across study populations, treatment protocols, and outcomes.
We review diagnosis, prior treatment, current medications, safety considerations, and the current care plan to determine whether off-label rTMS may be appropriate for each patient.
If PTSD symptoms remain significant after psychotherapy, medication, or both, we can evaluate whether off-label rTMS may be appropriate. At The Mind Grove TMS Center in Colorado Springs, we review your diagnosis, prior treatment, current medications, safety considerations, and current care plan before recommending treatment. We also explain the evidence, off-label status, and cost clearly before you decide whether to proceed. Contact us to schedule a consultation.
References
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Boggio, P. S., Rocha, M., Oliveira, M. O., Fecteau, S., Cohen, R. B., Campanhã, C., Ferreira-Santos, E., Meleiro, A., Corchs, F., Zaghi, S., Pascual-Leone, A., & Fregni, F. (2010). Noninvasive brain stimulation with high-frequency and low-intensity repetitive transcranial magnetic stimulation treatment for posttraumatic stress disorder. The Journal of Clinical Psychiatry, 71(8), 992–999. https://pubmed.ncbi.nlm.nih.gov/20051219/
Brown, R., Cherian, K., Jones, K., Wickham, R., Gomez, R., & Sahlem, G. (2024). Repetitive transcranial magnetic stimulation for post-traumatic stress disorder in adults. Cochrane Database of Systematic Reviews, 2024(8), CD015040.https://pubmed.ncbi.nlm.nih.gov/39092744/
Kozel, F. A., Motes, M. A., Didehbani, N., DeLaRosa, B., Bass, C., Schraufnagel, C. D., Jones, P., Morgan, C. R., Spence, J. S., Kraut, M. A., & Hart, J. (2018). Repetitive TMS to augment cognitive processing therapy in combat veterans of recent conflicts with PTSD: A randomized clinical trial. Journal of Affective Disorders, 229, 506–514. https://pubmed.ncbi.nlm.nih.gov/29351885/
Leong, K., Chan, P., Ong, L., Zwicker, A., Willan, S., Lam, R. W., & McGirr, A. (2020). A randomized sham-controlled trial of 1-Hz and 10-Hz repetitive transcranial magnetic stimulation (rTMS) of the right dorsolateral prefrontal cortex in civilian post-traumatic stress disorder. The Canadian Journal of Psychiatry, 65(11), 770–778. https://pubmed.ncbi.nlm.nih.gov/32379487/
Mayo Clinic. (2024). Post-traumatic stress disorder (PTSD): Symptoms and causes.https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
Schnurr, P. P., Hamblen, J. L., Wolf, J., Coller, R., Collie, C., Fuller, M. A., Holtzheimer, P. E., Kelly, U., Lang, A. J., McGraw, K., Morganstein, J. C., Norman, S. B., Papke, K., Petrakis, I., Riggs, D., Sall, J. A., Shiner, B., Wiechers, I., & Kelber, M. S. (2024). The management of posttraumatic stress disorder and acute stress disorder: Synopsis of the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals of Internal Medicine, 177(3), 363–374.https://pubmed.ncbi.nlm.nih.gov/38408360/
U.S. Food and Drug Administration. (2026). MeRT System (K260402).https://www.accessdata.fda.gov/cdrh_docs/pdf26/K260402.pdf
Virto-Farfan, H., Váscones-Román, F. F., Rivera, V., Karpenko, O., Bochkina, E., Parshakova, E., Sinev, A., Tafet, G. E., & Pacheco-Barrios, N. (2026). Efficacy of transcranial magnetic stimulation in the treatment of combat-related PTSD: A systematic review and meta-analysis. Frontiers in Psychiatry, 17, 1756576.https://pubmed.ncbi.nlm.nih.gov/41868833/
Wang, Y.-X., Lin, J.-Y., Zhang, C.-Y., Liu, J.-J., Hou, B.-Q., Nie, Q., Lu, J., & Xie, Y.-L. (2025). The effects of repetitive transcranial magnetic stimulation on post-traumatic stress disorder and parameter discussion: A meta-analysis based on randomized controlled trials. Neuropsychiatric Disease and Treatment, 21, 2145–2163.https://pubmed.ncbi.nlm.nih.gov/40988891/
Yuan, H., Liu, B., Li, F., Jin, Y., Zheng, S., Ma, Z., Wu, Z., Chen, C., Zhang, L., Gu, Y., Gao, X., & Yang, Q. (2023). Effects of intermittent theta-burst transcranial magnetic stimulation on post-traumatic stress disorder symptoms: A randomized controlled trial. Psychiatry Research, 329, 115533. https://doi.org/10.1016/j.psychres.2023.115533
Medical Disclaimer
The information in this blog is provided for educational purposes only and does not constitute medical advice. TMS therapy should only be pursued under the supervision of a licensed medical or psychiatric provider familiar with your full medical and psychiatric history. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.
Disclaimer
This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.