TMS and the PHQ-9: how we measure recovery from depression
In depression care, "feeling better" should never be a vague impression. When treatment is working, the change ought to be visible: in sleep, in energy, in the ability to get through an ordinary day — and in a number that both patient and clinical team can follow over time. At Fibroclinic we pair transcranial magnetic stimulation (TMS) with structured symptom measurement, and the tool we rely on most is the PHQ-9. In recent months, several of our patients have completed TMS treatment with improvements that were not only felt at home but clearly reflected in their scores.
What the PHQ-9 is
The PHQ-9 is a brief, internationally validated questionnaire that reviews the nine defining symptoms of depression — mood, interest in activities, sleep, energy, appetite, self-worth, concentration, restlessness or slowing, and thoughts of self-harm — over the previous two weeks. Each answer scores from 0 to 3, so the total ranges from 0 to 27:
- 0–4: minimal symptoms.
- 5–9: mild.
- 10–14: moderate.
- 15–19: moderately severe.
- 20–27: severe.
It takes only a few minutes to complete, which makes it practical to repeat throughout treatment. The score is a guide, never a verdict: we always interpret it within the clinical interview, alongside everything the questionnaire cannot capture.
A brief recap of TMS
TMS uses focused magnetic pulses to stimulate regions of the brain involved in mood regulation. Sessions are outpatient, require no anesthesia, and allow patients to return to their routine immediately afterward. It is a well-established option when depression has not responded adequately to medication. If you want the full clinical picture, our TMS overview explains how it works, step by step.
How the PHQ-9 guides a TMS treatment course
- Before the first session we establish a baseline score together with a complete psychiatric evaluation.
- During the course we re-apply the questionnaire at regular intervals, so the trend — not a single number — tells the story.
- In clinical practice, a drop of 50% or more from baseline is commonly considered a response, and a score below 5 suggests remission.
- The score never travels alone: we weigh it against sleep quality, energy, appetite, concentration, and how the person is functioning at work and at home.
Measuring this way has a practical consequence: if the trajectory stalls, we can adjust the treatment plan early instead of discovering it weeks later.
What we are seeing at Fibroclinic
Several patients who recently completed their TMS course arrived with scores in the moderately severe or severe range and finished in the mild or minimal range, with day-to-day changes their families noticed first: deeper sleep, more energy in the morning, renewed interest in activities they had abandoned. Every course is individualized and results vary from person to person — which is precisely why we measure. The questionnaire turns each patient's progress into information we can act on.
Who might consider TMS
TMS is worth discussing when depression has persisted despite adequate medication trials, or when side effects have made medication difficult to sustain. It is not indicated for everyone: the evaluation reviews medical history and specific contraindications, such as metallic implants near the head or a history of seizures. The decision is always made jointly, within our interdisciplinary model.
If you or a family member live with depression that has not improved as expected, our team can walk you through the evaluation and explain what a measured, carefully followed TMS course looks like.