Positives

• A treatment-resistant depression case series secondary to Long COVID showed Montgomery-Åsberg Depression Rating Scale scores improving from 21.2 to 9.8, fatigue from 5.4 to 4.2, and cognitive function scores from 10.0 to 6.3 after rTMS Psychiatric Research and Clinical Practice.
  
  

Negatives

• Patients with treatment-resistant depression on standard TMS protocols commonly report no response, with roughly 4 in 10 not benefiting from a full course Yale Medicine.
• Patients in a Long COVID rTMS protocol have reported intolerable scalp pain forcing immediate discontinuation, and treatment effectiveness for depression decreased as fatigue severity increased PMC.

Hurdles & Side Effects

• TMS for Long COVID is essentially uninsured outside of FDA-approved indications (treatment-resistant depression, OCD); a typical 30-session course costs $10,000-$15,000 out of pocket and requires near-daily clinic visits over 6 weeks MDPI.
  
  
• A few patients reported pain at the stimulation site during treatment, but no serious adverse events have been documented in Long COVID rTMS series; the main practical barrier is the time and travel commitment ScienceDirect.