TMS vs Medication: Which Works Better for Treatment-Resistant Depression?
- Sophroneo Psychiatry
- Sep 15
- 7 min read
Updated: Oct 28
The Search for an Alternative to Antidepressants
At Sophroneo Behavioral Health, we see the frustration and exhaustion that comes with treatment-resistant depression (TRD). You've diligently tried multiple medications, hoping each new prescription would be the one to bring relief, only to be met with limited results and challenging side effects.
You are not alone. Research shows that approximately 30% of people with major depressive disorder do not respond to the first two courses of antidepressant medication. This condition, known as TRD, doesn't just prolong suffering, it increases the risk of more severe and longer-lasting episodes.
While the standard approach has been to switch or add more medications, this strategy has a low success rate. Fortunately, innovative, non-drug therapies like Transcranial Magnetic Stimulation (TMS) offer new hope. In this guide, our clinical team breaks down the evidence comparing TMS with medication to help you understand your options.
How Antidepressant Switching Works (and Why Results Are Limited)
The typical pharmacological strategy for TRD is to switch from one class of antidepressant to another (e.g., from an SSRI to an SNRI) or to augment the current drug with an additional medication. A clinical diagnosis of TRD is usually made after at least two of these attempts fail to produce meaningful improvement.
Unfortunately, for patients who have already not responded to initial treatments, simply trying another pill rarely brings robust relief. A landmark head-to-head clinical trial directly compared TMS to standard antidepressant switching. The results were stark: medication switching produced a response rate of only about 14.6% and a remission rate of just 4.9%. This means over 95% of patients in this group did not achieve remission. Furthermore, adding more drugs increases the risk of systemic side effects like weight gain, sexual dysfunction, or sedation.
What is Transcranial Magnetic Stimulation (TMS)
TMS is an FDA-approved, non-invasive brain stimulation therapy. During a session, a magnetic coil is placed gently against the scalp to deliver precise magnetic pulses to the dorsolateral prefrontal cortex (DLPFC), a region of the brain that is known to be underactive in individuals with depression. This targeted stimulation helps to normalize the neural circuits that regulate mood. A typical course of treatment involves daily 20-minute sessions over six to nine weeks. Because the therapy is non-invasive, patients remain awake and can return to their normal activities, including driving, immediately after each session.
How TMS Therapy Actually Works? A Step-by-Step Explanation
The science behind Transcranial Magnetic Stimulation (TMS) can seem complex, but the principle is quite straightforward and elegant. At Sophroneo, we often explain it to our patients as a way to gently "reawaken" and "retune" the specific parts of the brain that have become underactive due to depression.
Instead of using medication that circulates throughout your entire body, TMS uses targeted magnetic fields to stimulate the brain's own natural ability to heal. Here is a breakdown of the process.
What to Expect During a TMS Therapy Session
The entire therapy is a collaborative process designed for your comfort and safety. Here is what happens during a typical 20-minute session:
1. Precise and Gentle Coil Placement First, a cushioned electromagnetic coil is carefully placed against your scalp. Our clinical team uses precise measurements to target the dorsolateral prefrontal cortex (DLPFC), which is known as the brain's primary mood regulation center. This area is often underactive in individuals struggling with depression.
2. Delivering Safe Magnetic Pulses Next, the coil delivers a series of brief, repetitive magnetic pulses. This process is non-invasive, and the magnetic energy is the same type and strength as that used in an MRI machine. You will hear a clicking sound and feel a tapping sensation on your scalp during this phase, but it is generally not painful.
3. Stimulating Brain Cells (Neurons) These magnetic pulses pass harmlessly through the skull and generate a tiny, localized electrical current in the brain tissue directly beneath the coil. This current is just strong enough to stimulate the targeted nerve cells (neurons), causing them to fire and become active.
4. Rebuilding Brain Connections and Function This neuronal firing creates a powerful domino effect, encouraging the brain cells to start communicating more effectively. Over the full course of treatment, this repetitive stimulation promotes neuroplasticity, the brain's ability to form new, healthier connections. Ultimately, this process helps to "reset" the dysfunctional brain patterns that contribute to depressive symptoms, leading to improved mood and a reduction in symptoms.
A Note From Our Clinical Team at Sophroneo:
"Think of TMS as physical therapy for your brain's mood circuits. We aren't introducing anything foreign into the body; we are simply using magnetic fields to help the brain rebuild and strengthen its own natural, healthy pathways. This is why the results can be so profound and lasting for our patients."
The Evidence & Success Rates: A Clear Comparison
The clinical evidence starkly contrasts the TMS vs Medication: approaches. The same head-to-head trial mentioned earlier provides a direct comparison of success rates.
Medication Switching: Response Rate: ~15% | Remission Rate: ~5%
TMS Therapy: Response Rate: ~38% | Remission Rate: ~27%
In this direct comparison, TMS was roughly 2.5 times more likely to produce a response and over 5 times more likely to lead to full remission than switching medications. Other real-world studies confirm these findings, consistently showing that about two-thirds of TMS patients experience significant improvement, and roughly one-third achieve full remission. For many, these results are also durable, with benefits lasting for months or even years.
TMS vs Medication: Pros and Cons of Each Approach
To help you weigh your options, here is a clear, side-by-side comparison.
Antidepressant Switching and Augmentation
Pros: Widely available, familiar to most providers, and typically covered by insurance.
Cons: Very low success rates in TRD patients, high risk of systemic side effects (weight gain, sexual dysfunction, etc.), and a frustrating trial-and-error process.
Transcranial Magnetic Stimulation (TMS)
Pros: Clinically proven higher response and remission rates, non-invasive with no systemic side effects, and covered by most insurance plans for TRD.
Cons: Requires a time commitment for daily sessions, can cause mild and temporary scalp discomfort, and requires access to a certified TMS clinic.
Is TMS Right for You?
TMS is a powerful and promising therapy, but it’s important to determine if you are a suitable candidate. The first step is a thorough evaluation with a qualified mental health professional.
At Sophroneo, we can help you determine if you are eligible. Typical criteria include:
A confirmed diagnosis of Major Depressive Disorder.
A documented history of failing to respond to at least two antidepressant medications.
No history of seizures or epilepsy.
No implanted metallic or electronic devices in or near the head (e.g., pacemakers, cochlear implants).
If you’ve tried multiple antidepressants without success and are tired of the side effects, TMS may be the breakthrough you've been looking for. Our team at Sophroneo offers a free, no-obligation consultation to review your treatment history and help you understand your insurance coverage, so you can make an informed decision.
The Takeaway: A New Path Forward
For people suffering from treatment-resistant depression, continuing to switch antidepressants can feel like spinning your wheels while side effects mount. Transcranial Magnetic Stimulation is a clinically validated, non-drug alternative with a proven track record of higher success rates and a much more favorable side-effect profile.
While TMS does require a time commitment, many of our patients find that it provides the meaningful relief they had been searching for after years of struggling. If you are battling depression that hasn't responded to medication, we encourage you to schedule a free consultation with our team at Sophroneo to discuss your next steps.
Ready to Explore NeuroStar TMS?
At Sophroneo Behavioral Health & TMS, we understand the mental and financial weight of seeking treatment. That’s why we offer personalized consultations, transparent pricing, and compassionate guidance to help you determine if NeuroStar TMS is right for you.
Visit https://www.soppsych.com/contact or call us at 770-999-9495 to book your consultation.
Frequently Asked Questions (FAQ): TMS vs. Medication
1) What counts as treatment-resistant depression (TRD)?
TRD is generally diagnosed after your depression has not improved despite trying at least two different first-line antidepressant medications at an adequate dose for a sufficient duration (typically 6–8 weeks each). Our clinicians can confirm this diagnosis during your evaluation.
2) How fast does TMS work, and how long do the results last?
Many of our patients begin to notice improvements within 2-4 weeks of starting treatment, with the full benefits often realized by the end of the 6-week course. The results can be long-lasting, with some patients remaining in remission for many months or years. Maintenance sessions can also be used if symptoms begin to return.
3) Can I stay on my medications during TMS?
Yes, in most cases. TMS is often used as an adjunctive therapy alongside your current medication and psychotherapy. Our providers will work with you to determine the best treatment plan for your specific situation.
4) What are the most common side effects of TMS?
The most common side effects are temporary scalp discomfort or a mild headache at the treatment site, which typically fade within the first few sessions. Because TMS is non-invasive and targeted, it does not cause systemic side effects like weight gain, nausea, or sexual dysfunction.
5) Is TMS covered by insurance?
Yes, most major insurance plans, including Medicare and TRICARE, now cover TMS for treatment-resistant depression when the clinical criteria are met. Our team at Sophroneo specializes in handling the insurance pre-authorization process to verify your benefits and ensure you get the coverage you're entitled to.
6) Who may not be a good candidate for TMS?
Individuals with a history of seizures or those with certain ferromagnetic or electronic implants in or near their head (such as aneurysm clips or cochlear implants) may not be eligible. The best way to know for sure is to schedule a consultation with our team for a thorough evaluation.
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