COVID-19's long-term effects, known as
Long-COVID, present psychiatric and physical challenges in recovered patients. Similarly, rare long-term post-vaccination side effects, resembling
Long-COVID, are emerging (called Post-
Vaccine). However, effective treatments for both conditions are scarce. Our clinical experience suggests that
transcranial magnetic stimulation (TMS) often
aids recovery in
Long-COVID and Post-
Vaccine patients. However, its effectiveness is reduced in patients with severe
fatigue. Therefore, we retrospectively analysed Tokyo TMS Clinic's outpatient records (60 in total; mean age, 38 years) to compare
Long-COVID and post-
vaccine patients' characteristics and symptoms, assess the impact of TMS on their symptoms, and investigate the role of
fatigue in depression recovery with TMS. The primary outcome was the regression coefficient of the initial
fatigue score on depression score improvement using TMS. Secondary outcomes included psychiatric/physical scores before and after TMS and their improvement rates. We found no differences in the initial symptoms and background factors between
Long-COVID and Post-
Vaccine patients. After ten TMS sessions, all psychiatric and physical symptom scores improved significantly. TMS improves depression,
insomnia, anxiety, and related neuropsychiatric symptoms, which were the primary complaints in this study. Thus, we conclude that TMS improves depression and anxiety. The effectiveness of TMS in treating depression in
Long-COVID and Post-
Vaccine patients decreased as
fatigue severity increased. In conclusion, TMS relieved depressive symptoms following
COVID-19 and vaccination; however,
fatigue may hinder its effectiveness.