TMS vs Antidepressants · Is TMS right for me?

After Two Antidepressants: How TMS Compares to Your Next Medication

Written by Kevin P. Muthu, MD
Reviewed November 2026

If you've tried two or more antidepressants and still don't feel like yourself, you're not out of options, and the next step doesn't have to be another pill.

How depression treatment got here

For much of the 20th century, talk therapy was the main treatment for depression. Antidepressants arrived in the 1950s, and newer medications like Prozac became widely used in the late 1980s and 1990s.

Combining therapy with medication works better than either alone, and that combination has helped millions of people. But many people are still left waiting to feel better.

What the research says about trying "one more medication"

The largest real-world study of depression treatment, the NIMH-funded STAR*D trial, followed thousands of patients through up to four rounds of treatment. About one in three reached remission, meaning they felt essentially well, on their first antidepressant. By the third and fourth rounds, that dropped to roughly one in seven.

Later-line options also tend to carry more side effects. These include medications such as tricyclics, MAOIs, lithium, and antipsychotic augmentation, which can cause weight gain, sedation, sexual side effects, and metabolic changes. With each new trial, the chance of benefit shrinks while the chance of side effects grows.

A different kind of treatment

Transcranial magnetic stimulation (TMS) has been FDA-cleared for depression since 2008. Instead of a medication that circulates through your whole body, TMS uses focused magnetic pulses to stimulate specific brain regions involved in mood. Over a course of treatment, this helps restore healthier activity in the circuits that become underactive in depression.

TMS involves:

• No anesthesia or incisions. You're awake and comfortable throughout.
• No systemic medication effects. There's no weight gain, sexual side effects, or stomach upset from the treatment itself.
• No downtime. You can drive yourself to and from appointments and return to work the same day.

The most common side effects are headache and scalp discomfort during early sessions, which usually fade within the first few weeks. Seizures are rare. I'll review your history to make sure TMS is safe for you.

How well does TMS work?

In the randomized, sham-controlled trial that led to FDA clearance of deep TMS for depression (212 patients; Levkovitz et al., World Psychiatry, 2015), 33% of patients reached remission after 5 weeks, more than double the 15% with sham treatment. At 16 weeks, 44% had responded and 32% were in remission. These were patients whose depression had not responded to medications.

Real-world results are often higher. In a large registry of patients treated with deep TMS in clinical practice, 82% of patients who completed 30 sessions responded and 65% reached remission (Tendler et al., Psychiatry Research, 2023). A 2024 randomized trial in treatment-resistant depression (ASCERTAIN-TRD, Molecular Psychiatry 2024) also found that adding TMS outperformed switching antidepressants to venlafaxine or duloxetine.

Every person is different, and no treatment works for everyone. But for many people who have already tried two medications, TMS offers a better chance of real improvement, with fewer side effects, than the next pill on the list.

Is TMS right for you?

TMS may be a good fit if you:

• Have tried at least one or two antidepressants without enough improvement
• Couldn't tolerate the side effects of medication
• Feel stuck despite therapy
• Want a treatment that doesn't add another medication

TMS isn't appropriate for everyone, for example people with certain metal implants in or near the head. A careful evaluation comes first.

What treatment looks like

A typical course involves short sessions (3 - 20 min), five days a week, for four to six weeks. Many patients notice changes within the first few weeks. I also offer structured maintenance sessions afterward to help keep the gains.

Insurance

Most commercial insurers and Medicare, and many Medicaid plans cover TMS for depression when certain criteria are met, usually after two or more medication trials. My office will help you understand your options, including out-of-network benefits.

This article is for educational purposes and isn't a substitute for individualized medical advice. Individual results vary.