Deep TMS vs. Standard rTMS: The Real Differences (and What We Offer in Hayward)

If you’re comparing TMS clinics, you’ve probably run into two terms that get used loosely: Deep TMS and standard rTMS. They’re related but genuinely different technologies, and the difference matters depending on what you’re being treated for. Here’s a straight explanation — including what we do and don’t offer at Exxceed Wellness in Hayward.

The short version

Both are FDA-cleared, non-invasive forms of transcranial magnetic stimulation. The main difference is the coil. Standard rTMS uses a figure-8 coil that stimulates a focused area of cortex. Deep TMS uses a helmet-style “H-coil” (made by BrainsWay) that reaches somewhat deeper and broader brain regions. That coil difference is why the two have different FDA clearances.

Standard rTMS (and iTBS)

The original FDA-cleared TMS protocol, delivered to the left dorsolateral prefrontal cortex, is well-studied and well-tolerated for major depressive disorder and treatment-resistant depression. A faster variant, iTBS (theta-burst, sometimes branded “Express TMS”), delivers a clinically comparable depression protocol in about three minutes instead of twenty to forty. These are the protocols we offer at Exxceed Wellness, for depression.

Deep TMS

The BrainsWay H-coil has additional FDA clearances that standard rTMS does not — most notably OCD (cleared in 2018) and smoking cessation. If a clinician is talking about TMS for OCD specifically, they’re talking about one of the TMS systems FDA-cleared for OCD — focal figure-8 systems like our Magstim Horizon 3.0, or BrainsWay’s Deep TMS (H-coil).

What we offer — and what we don’t

At Exxceed Wellness we provide standard 10Hz rTMS and iTBS/Express for depression. We do not offer Deep TMS. For OCD, we provide medication management, ERP referral, and focal TMS on our Magstim Horizon 3.0 (an FDA-cleared adjunct for OCD); if Deep TMS is an appropriate next step, we’ll explain it and help you find a provider who offers it. We’d rather tell you that plainly than blur the line between technologies.

So which is “better”?

Neither — it depends on the diagnosis. For depression, standard rTMS and iTBS have a strong evidence base and are what most people start with. For OCD, the FDA-cleared TMS option is Deep TMS, which is a different device and a different clinical decision.

Educational only; not medical advice. FDA clearances and clinical fit depend on your specific situation. To talk through depression treatment options in Hayward, CA or via California telehealth, schedule a consultation with Nefretiri Abat, J.D., PMHNP-BC.