If you’re exploring treatment for depression, you may feel stuck between options. Maybe you’ve tried antidepressants and haven’t felt enough relief. Maybe you’re concerned about side effects. Or maybe you’re hearing about transcranial magnetic stimulation (TMS) therapy for the first time and wondering how it compares.

Both TMS and antidepressant medications are evidence-based treatments for depression. They work in different ways, and each comes with its own benefits and limitations. Understanding those differences can help you have a more informed conversation with your provider about what fits your needs.

At Columbia Mental Health, we offer therapy, psychiatry, medication management, and advanced interventional services, so treatment plans can be tailored rather than one-size-fits-all.

Understanding TMS and antidepressants

Antidepressants are medications, such as SSRIs or SNRIs, that adjust brain chemistry over time. They are often a first-line treatment for depression and are widely prescribed. Most are taken daily and may take several weeks before noticeable changes occur.

NeuroStar TMS® is a non-drug treatment that uses focused magnetic pulses, similar in strength to an MRI, to stimulate underactive areas of the brain involved in regulating mood. TMS is FDA-cleared for the treatment of major depressive disorder in adults, as an add-on therapy for adolescents ages 15–21, and for obsessive-compulsive disorder in adults.

TMS is not electroconvulsive therapy and does not involve anesthesia or sedation. Treatment is delivered in scheduled sessions at one of our clinics, and clients remain awake and alert throughout.
Both options are commonly used in mental health care. The difference lies in how they work and who may benefit most from each.

Pros and considerations of TMS therapy

TMS may be a good option for individuals with difficult-to-treat depression or those who have not experienced sufficient relief from antidepressants.

Potential benefits include:

• Non-drug treatment option
• No daily medication required
• Does not typically cause weight gain or sexual side effects associated with some antidepressants
• No negative effects on memory or cognition

The most common side effect is mild to moderate discomfort or headache at the treatment site, which often decreases during the first week of sessions.

Considerations include:

• A time commitment, often five sessions per week for several weeks
• Not everyone responds
• Treatment must be delivered in-clinic

Pros and considerations of antidepressants

Antidepressants are widely available and often the first step in treating depression.

Potential benefits include:

• Accessible and commonly covered by insurance
• Many medication options are available
• Can also help with anxiety, OCD, and other mood-related concerns
• Flexible treatment schedule without in-clinic visits

Considerations include:

• Possible side effects such as fatigue, weight changes, or libido changes
• Several weeks may pass before full benefits are felt
• Finding the right medication and dose can take time
• Some individuals do not experience sufficient improvement

Through thoughtful medication management, psychiatric providers monitor progress and adjust treatment as needed. The process is ongoing rather than fixed.

Who might benefit most from TMS or medication

TMS may be worth discussing if:

• You’ve tried multiple antidepressants without meaningful improvement
• Side effects from medication have been difficult to tolerate
• You prefer a non-drug approach
• You have difficult-to-treat depression

Medication may be a good starting point if:

• You are early in treatment
• Symptoms are mild to moderate
• You prefer a treatment plan that does not require frequent in-clinic visits
• You have responded well to medication in the past

In some cases, people use both approaches at different times in their treatment journey. The right path depends on symptom severity, past treatment history, medical factors, and personal preference.

What we know about TMS outcomes

TMS has been widely used across the country as a treatment for depression. More than 8.2 million NeuroStar® TMS treatments have been delivered to over 223,000 patients.

In a real-world study, 83% of patients who completed their NeuroStar® TMS treatment cycle experienced measurable improvement in their depression symptoms, and 62% reached remission, meaning their symptoms were reduced to the point that they would no longer meet criteria for major depressive disorder.

While individual results vary, these outcomes help explain why TMS is often considered when antidepressants haven’t provided enough relief.

What about Spravato® and other alternatives?

Spravato® is an FDA-approved nasal spray used in conjunction with an oral antidepressant for adults with difficult-to-treat depression. It works differently from traditional SSRIs and is administered in our clinics under medical supervision.

Unlike daily antidepressants, Spravato® is given on a structured schedule and monitored closely during each visit. Some individuals consider it when other treatments, including medication, have not provided enough relief.

More details about how this option fits within psychiatric care are available through our Spravato® treatment services, including safety monitoring and eligibility criteria.

Choosing the right path with Columbia Mental Health

Depression does not look the same for everyone, and treatment shouldn’t either. Some people begin with medication and later explore TMS. Others try several medications before considering interventional options. Many combine therapy with whichever medical approach they choose.

Columbia Mental Health has served Maryland and Virginia for more than 30 years and is a regional leader in interventional psychiatry. Our team includes therapists, psychiatrists, and advanced practice providers who work together to build individualized treatment plans based on your history, goals, and preferences.

If you’re ready to take the next step in your mental health journey, click here to reach out to our team of empathetic mental health care experts. For existing clients, please click here and find your office location to contact your office directly.

Visit NeuroStar.com for full safety and prescribing information.