If you’re planning a course of TMS — or you’ve done TMS before and want better results the second time — there’s a straightforward add-on treatment worth knowing about: transcranial direct current stimulation, or tDCS.
Combining tDCS with TMS doesn’t require extra visits, doesn’t add significant time to your sessions, and is well-tolerated. And in 2024, a rigorous randomized clinical trial confirmed what clinicians had begun to observe in practice: the combination outperforms either treatment used alone.
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that delivers a low-level electrical current — well below the threshold of discomfort — to targeted areas of the brain through electrodes placed on the scalp. It modulates the excitability of neurons in the targeted region, making them more or less likely to fire. Applied to the areas involved in mood regulation, tDCS supports the kind of cortical changes associated with antidepressant response.
tDCS is not the same as TMS. TMS uses focused magnetic pulses to directly stimulate neurons. tDCS uses a weak, continuous direct current to shift the electrical state of a brain region over time. They complement each other rather than duplicate each other — which is the basis for combining them.
The strongest clinical evidence for tDCS and TMS combination therapy comes from a 2024 randomized clinical trial published in JAMA Network Open by Zhou and colleagues.
The trial enrolled 240 patients with major depressive disorder across multiple centers and compared four groups: combined active tDCS and active rTMS; sham tDCS with active rTMS; active tDCS with sham rTMS; and double sham. The treatment course was two weeks.
The result was clear: the combined active tDCS and active rTMS group had significantly greater reduction in depressive symptoms — measured by the Hamilton Depression Rating Scale — than any of the other three groups. Neither treatment alone matched the combination.
Equally important: the safety profile was comparable across all four groups. Adding tDCS to TMS did not meaningfully increase adverse effects.
A companion study from the same research group, published in BMC Medicine in 2024, found that after 10 sessions of combined treatment, the tDCS and rTMS group showed more significant improvements in memory, visuospatial function, and overall neuropsychological performance compared to either treatment alone — suggesting that the cognitive benefits extend beyond mood.
What this means for patients: For patients with major depressive disorder, combining tDCS with TMS produces better outcomes than choosing one. And it does so without requiring additional appointments.
tDCS is administered in the same session as TMS. The electrodes are placed on the scalp before treatment begins, and the stimulation is applied during the same visit as your scheduled TMS session. The two methods are targeted at overlapping or complementary regions of the prefrontal cortex.
The practical result: you don’t need to add visits to your schedule. You’re already here for TMS. The tDCS component adds minimal time and no additional trips.
tDCS and TMS combination therapy is worth considering if you:
Because the Zhou et al. trial enrolled patients with MDD — not only those with treatment-resistant cases — the evidence supports using this combination earlier in the treatment pathway, not just as a last resort.
tDCS is well-tolerated. The most commonly reported sensations are mild tingling or slight warmth at the electrode sites during stimulation — both temporary and generally mild. The Zhou et al. 2024 trial confirmed that the combined tDCS and TMS approach had a safety profile comparable to each treatment individually, with no meaningful increase in adverse events in the combination group.
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that uses a weak electrical current to modulate the excitability of neurons in targeted brain regions. In depression treatment, it is typically applied to the dorsolateral prefrontal cortex — the same region targeted by TMS. tDCS does not directly trigger neuron firing the way TMS does; instead, it shifts the electrical state of neurons, making the targeted region more responsive to stimulation and to the effects of TMS delivered in the same session.
Yes. tDCS can be applied immediately before or alongside a TMS session. The electrodes are positioned on the scalp before treatment begins, and the stimulation is administered during the same visit. No additional appointments are needed.
The 2024 Zhou et al. JAMA Network Open trial found that the combination treatment was well-tolerated, with a safety profile consistent with each treatment applied individually. The most common sensations with tDCS are mild tingling or warmth at the electrode sites during stimulation. No significant increase in adverse events was observed in the combined group compared to TMS alone.
TMS uses brief, focused magnetic pulses to directly depolarize neurons in the target area. tDCS uses a low, continuous direct current to shift the resting electrical potential of neurons — making them easier or harder to activate depending on polarity. They work through different mechanisms, and when applied together they produce additive effects on mood-relevant cortical circuits, as demonstrated in the Zhou et al. 2024 trial.
Yes. tDCS and TMS combination therapy is available at Interventional Psychiatry of Philadelphia, 2401 Pennsylvania Ave, Suite 1C44-45, Philadelphia, PA 19130.
Your treating clinician makes that determination based on your diagnostic history, prior treatment response, and clinical goals. If you’re interested in the combination, raise it during your consultation or at your next clinical visit.
The 2024 JAMA Network Open evidence is clear: patients with major depressive disorder do better when tDCS is added to TMS. If you’re planning TMS — or you’ve done it before and want a stronger protocol — this is the right conversation to have.
Call 215-222-0310 or request an appointment online. Our practice is located at 2401 Pennsylvania Ave, Suite 1C44-45, Philadelphia, PA 19130, and we see patients from throughout Philadelphia and the surrounding region.
