Antidepressants vs. TMS: Which Depression Treatment is Right for You?

You may have heard of TMS therapy as an innovative and increasingly popular treatment for depression, especially for those who haven’t found relief with traditional antidepressants. But what’s the difference between these two depression treatments, and which one is right for you? 

In this article, we share how antidepressants and TMS treatment work, compare their differences, and help you understand which option may be more suitable for you. 

How does antidepressant medication work?

Antidepressants are typically the first line of treatment for depression. They work by adjusting the levels of neurotransmitters – like serotonin, norepinephrine, and dopamine – which influence mood, energy, and emotional regulation.

There are different classes of antidepressants, and each works in a slightly different way. Some of the most common types include:       

• Selective serotonin reuptake inhibitors (SSRIs): These are usually the first choice for treatments. SSRIs increase the level of serotonin in the brain and generally have fewer side effects than other antidepressants. Examples include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and Escitalopram (Lexapro). 
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): These medications increase both serotonin and norepinephrine. They can be helpful if you’ve tried SSRIs and haven’t responded well to them. Examples include venlafaxine (Effexor XR), duloxetine (Cymbalta), and desvenlafaxine (Pristiq). 
• Atypical antidepressants: These are antidepressants that don’t fit neatly into other categories, like bupropion (Wellbutrin), mirtazapine (Remeron), vortioxetine (Trintellix), and Trazodone. 
• Tricyclic antidepressants (TCAs): These are an older class of antidepressants that affect multiple neurotransmitters. However, TCAs often have more side effects so they’re usually only prescribed when newer medications haven’t worked. Examples include amitriptyline, nortriptyline (Pamelor), and imipramine. 
• Monoamine oxidase inhibitors (MAOIs): These are another type of older antidepressant. MAOIs require strict dietary restrictions and careful monitoring due to the risk of serious side effects and interactions. Examples include phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan).  

Antidepressants are usually taken every day, and it can take several weeks before you begin to notice any improvement. They can offer significant relief from depression symptoms, but they’re not always effective for everyone. Some people might experience side effects like weight gain, sexual dysfunction, sleep changes, or emotional numbness, while others find that the medications aren’t enough to relieve depression symptoms.  

In cases where a person doesn’t respond to medications, transcranial magnetic stimulation (TMS) can be an alternative depression treatment. 

How does TMS therapy work?

Transcranial magnetic stimulation (TMS) is a non-invasive, brain stimulation treatment that uses magnetic pulses to stimulate nerve cells in specific regions of the brain involved in mood regulation. It focuses particularly on the dorsolateral prefrontal cortex (DLPFC), a part of the brain that’s responsible for executive function, decision-making, and emotional regulation. 

This region is often underactive in people with depression, particularly on the left side, while the right side can become overactive and reinforce negative thoughts and emotional withdrawal. TMS helps to rebalance this activity, either by stimulating the left DLPFC or calming the right side, depending on the patient’s unique depressive symptoms.  

What happens in a TMS session?

TMS is usually delivered in a clinical setting, and patients remain awake and alert throughout the treatment. During each session, a coil is gently placed against the scalp, delivering targeted magnetic pulses to the brain. The treatment is painless, doesn’t require any anesthetic or sedation, and typically lasts 20 to 40 minutes. Sessions are usually scheduled five days a week for four to six weeks. 

There’s no downtime after a TMS therapy session, so patients are free to continue with their usual daily activities, including driving back home or to work. Unlike antidepressants, TMS works directly on the brain without affecting other systems of the body. This means it doesn’t have the same side effects, like weight gain, fatigue, or sexual dysfunction. 

There are a few different types of TMS therapy. The most common is repetitive transcranial magnetic stimulation (rTMS). Other types include accelerated TMS (aTMS), which offers a faster treatment protocol, and deep transcranial magnetic stimulation (dTMS), which targets deeper and broader brain regions. 

Antidepressants vs TMS therapy for treating depression 

Now that we’ve understood the basics of each depression treatment, let’s take a closer look at the differences between each of them. 

Effectiveness

Antidepressants can be effective for treating mild to moderate depression, but nearly a third of patients with depression are considered ‘treatment resistant’. This means they don’t experience sufficient relief from medication alone (this is also known as treatment-resistant depression or TRD). 

In 2006, a massive antidepressant trial called the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study reported that 67% of adults with major depressive disorder (major depression) achieved remission after four rounds of antidepressants. But a reanalysis in 2022 found that the actual remission rate was closer to 35%, with less than 2% of patients responding to a third or fourth antidepressant.   

For patients who’ve tried to or more medications without success, TMS therapy offers an alternative. Studies show that about 45% to 60% of patients respond to TMS and up to 40% achieve full remission. The treatment is especially effective for TRD, but it’s also showing promise for numerous other mental health conditions, including anxiety, PTSD, and OCD. 

Side effects

One of the main advantages TMS has over antidepressants is its minimal side effects. Most people only experience mild discomfort like: 

• Scalp discomfort 
• Twitching in the facial muscles
• Mild headaches
• Fatigue 
• Dizziness. 

All of these effects tend to be temporary and resolve on their own after treatment. On the other hand, antidepressant medications can cause a range of side effects, including:

• Weight gain
• Sexual dysfunction
• Fatigue or drowsiness
• Dry mouth
• Gastrointestinal issues. 

For some people, these side effects can be extremely unpleasant. In those cases, TMS may be a more suitable option. 

Convenience

In one sense, antidepressants are convenient in that they’re only taken once a day and you can usually take them from wherever you are. But in another sense, it can take months of trial and error before you find the right medication and dosage for you. This can understandably be a distressing experience for someone trying to find relief.  

TMS therapy, on the other hand, is initially more intensive. You’re usually required to attend one session per day, five days a week, for a total of four to six weeks. Once the treatment schedule is completed, however, many patients find lasting symptom relief. There are also other options, like accelerated TMS, which require a shorter time commitment.  

Cost

Antidepressants are generally more affordable upfront, especially when they’re covered by insurance or available in a generic form. But the cost of long-term prescriptions and medication management appointments can add up over time. 

TMS therapy costs more per session, but it’s covered for treatment-resistant depression by most major insurance providers. You might still have some out-of-pocket costs, but they’ll be much lower with insurance coverage. 

Which depression treatment is right for you?

Now that you know a bit more about TMS therapy and antidepressants, you might have a better idea which one is more suitable for you. If not, here’s a bit more guidance. 

You might prefer traditional antidepressant medications if you: 

• Are experiencing mild to moderate depression
• Have had positive results with antidepressants in the past
• Can tolerate common side effects like fatigue, weight changes, gastrointestinal discomfort, or sexual dysfunction
• Are looking for a convenient, at-home treatment option. 

You might prefer TMS therapy if you:

• Have treatment-resistant depression (i.e. you’ve tried at least two antidepressants without sufficient improvement)
• Are experiencing significant side effects from medications
• Prefer a non-invasive, drug-free approach to depression treatment
• Are looking for a therapy with fewer long-term side effects and proven effectiveness. 

At the end of the day, the best treatment for depression will depend on your unique circumstances, medical history, how you’ve responded to medications in the past, and your tolerance for side effects. There’s no one-size-fits-all answer, and what works well for one person might not work for you. 

If you’d like a comprehensive, personalized approach to depression treatment, contact our friendly and compassionate team at Psychiatry Treatment Centers. We can help develop a tailored treatment plan that aligns with your needs and preferences, whether that includes antidepressants, TMS therapy, Spravato (esketamine), psychotherapy, or a combination of these options. 

Schedule an appointment with us today.