TMS and Spravato® : For When Antidepressants Fall Short

When you’re trying to improve your quality of life while managing depression, it’s likely that you’ve discussed the option of antidepressants with your providers.

Antidepressants are medications that are meant to help reduce symptoms of depression by boosting the hormones in the brain that are in charge of mood regulation. In CDC research taken from 2023, approximately 11.4% of U.S. adults took prescribed medication for their depression symptoms.

With effective medication management, antidepressants can often play an essential role in your mental health journey; however, that’s not the case for everyone.

For some people, it’s possible that antidepressants aren’t giving them the results they need to improve their mental health. If you believe that antidepressants aren’t working for you, you shouldn’t lose hope. There are still alternatives worth exploring.

Read on to learn how to know if your antidepressants aren’t effective enough. Then we’ll give you information on TMS and Spravato®, two options for treatment-resistant depression.

How to determine if your antidepressants aren’t doing enough

Antidepressants aren’t a guaranteed solution for every single person with depression symptoms — some people don’t experience reduced depression symptoms from their medication.

Between 30% and 50% of people who take a first-choice antidepressant don’t experience significant improvement in their symptoms.

Here are some signs that your antidepressants are falling short:

You’re having persistent or worsening side effects, such as nausea or weight gain.
You’re still experiencing overwhelming negative feelings on a regular basis.
You don’t feel more energized or like you’re in a better mood.
The positive effects of antidepressants have worn off because your body has become tolerant to them.

Keep in mind that you might start to experience the effects after a couple of weeks of starting an antidepressant, and it can take up to eight weeks to experience the full effects.

If you’ve gone through at least two full trials of an antidepressant without experiencing reduced symptoms, you may be diagnosed with treatment-resistant depression. It affects approximately 30% of people with major depressive disorder.

According to the results of the STAR*D trial (Sequenced Treatment Alternatives to Relieve Depression):

Nearly 2 out of 3 patients failed to achieve remission with first line antidepressant treatment. 1 out of 3 failed to achieve remission after four antidepressant treatments.

Likelihood of discontinuing treatment due to side effects increased with each successive

medication attempt.

What you need to know about TMS

If your antidepressant isn’t performing to its full potential, your provider may recommend adding transcranial magnetic stimulation (TMS) therapy to your treatment plan. It’s a noninvasive treatment that sends electromagnetic pulses to the brain using a magnetic coil. It’s most often used to help people who have treatment-resistant depression experience the improvements they’re looking for.

The goal of TMS therapy is to stimulate underactive parts of the brain such as the left dorsolateral prefrontal cortex that are contributing to depressive symptoms. This area is associated with the reward center and contributes to emotional regulation and problem-solving. TMS stimulates this area to alter the neuronal networks to improve mood and cognitive functioning, treating the root of the problem, not just the symptoms.

TMS therapy involves 36 sessions over the course of six weeks. It’s an outpatient treatment that doesn’t require any anesthesia or sedation.

In most cases, it’s safe to continue taking your antidepressants while going through TMS sessions. A failed medication trial doesn’t have to mean that it didn’t work at all. There could be some benefit but insufficient or it has caused side effects.

TMS is a treatment option that works better than medication AND doesn’t have side effects.

What you need to know about Spravato®

It’s possible that your oral antidepressant needs a companion, or a complete replacement. That’s where esketamine comes in.

Spravato®, the brand name for esketamine, is a nasal spray that can be taken in addition to an oral antidepressant, or on its own. You administer the spray yourself under medical supervision. On average, Spravato® is given over the course of three to four months. You’ll receive treatments twice a week for the first month before moving to once a week for the next four weeks. Then you’ll move to treatment every week or every other week.

Esketamine is FDA approved as an option for treatment-resistant depression (TRD) or major depressive disorder with suicidal thoughts or behavior. It works by binding to the glutamate receptors in the brain to increase the level of brain-derived neurotrophic factor. This is a protein that contributes to the brain’s neuroplasticity. Essentially, the medication helps your brain adapt to new stimuli. You can improve cognitive functions, such as memory, while also improving your mood.

Spravato® may help reduce potential side effects from oral antidepressants if you’re continuing to take them.

Psychiatry Treatment Centers provides alternative therapies for depression

Everyone’s mental health journey is different, which means everyone’s treatment plan can be different as well. Even though antidepressants work well for many people, you might need a bit more to reduce your depression symptoms and improve your overall quality of life. At PTC, we can help you explore alternative options, such as TMS therapy and Spravato®, to determine if they’re right for you.

Reach out to our team by phone today for more information or to schedule an initial appointment. You can also book your initial appointment online now.