Exploring TMS treatment barriers in TRD: A novel clinical population study on anticipated and experienced treatment barriers

Background: Transcranial Magnetic Stimulation (TMS) is an established treatment for Treatment-Resistant Depression (TRD), yet access and adherence remain challenging. Objective: To identify perceived and experienced barriers to TMS and strategies that support treatment completion in a real-world clinical setting. Methods: Adults with TRD (N = 38) initiating a standard 6-week TMS course at a Minnesota clinic completed pre- and post-treatment surveys. Measures included TMS knowledge, anticipated and experienced barriers, and open-ended responses about treatment experiences. Quantitative analyses compared barrier rankings across timepoints; qualitative data were thematically analyzed. Results: No barrier rankings changed significantly from pre- to post-treatment, though accessibility approached significance. The most common barriers were transportation, time and scheduling demands, cost/insurance concerns, and uncertainty about efficacy. Open-ended responses emphasized the disruptive impact of treatment frequency, TRD symptoms themselves as barriers, and the strain of logistical and financial planning. Supports that facilitated completion included family and workplace flexibility, proactive scheduling, and clinic staff responsiveness. Conclusions: Barriers to TMS extend beyond cost to include practical, psychological, and logistical challenges. Individualized support, flexible scheduling, and insurance navigation may reduce burden and improve completion rates. Patient interest in shorter or accelerated TMS (aTMS) highlights the importance of documenting whether emerging protocols reduce or shift these barriers.