The National Institute of Mental Health estimates that 21 million U.S. adults experienced at least one major depressive episode in 2021. For some, the first treatment brings meaningful improvement. For others, medication helps only partially, causes difficult side effects, or does not provide the hoped-for relief.
Living with depression in Richmond, VA, while trying one treatment after another can leave you feeling discouraged. You may wonder whether you have failed treatment or whether nothing else will work.
An incomplete response to medication is not a personal failure. Depression is a complex condition, and people respond differently to individual medications, psychotherapy approaches, and other treatments. When a previous plan has not been enough, the next step is not to blame yourself. It is to reassess your needs, review the available options, and build a plan around your diagnosis, treatment history, safety, and goals.
At WHOA Wellness, we begin with that fuller picture. We listen to what you have tried, what helped even a little, what was difficult to tolerate, and how depression is affecting your daily life. For eligible adults with major depressive disorder, FDA-cleared TMS therapy may be one option within that conversation.
Depression Can Affect Far More Than Mood
Depression is not simply sadness or a negative attitude. Major depressive disorder can affect how a person thinks, sleeps, eats, moves, concentrates, relates to others, and experiences interest or pleasure.
Symptoms may include:
- Persistent sadness, emptiness, or irritability
- Loss of interest in previously meaningful activities
- Fatigue or a sense of moving more slowly
- Difficulty concentrating or making decisions
- Changes in sleep or appetite
- Feelings of guilt, worthlessness, or hopelessness
- Unexplained aches, tension, or physical discomfort
- Thoughts of death, self-harm, or suicide
Not everyone experiences depression in the same way. Some people can continue working or caring for others while feeling profoundly unwell internally. Others find that basic daily tasks become difficult.
Medical conditions, substance use, medication effects, grief, trauma, sleep disorders, and bipolar disorder can also contribute to depressive symptoms. A careful evaluation matters because the correct diagnosis shapes which treatments are appropriate.
When Medication Helps Only Part of the Way
Antidepressants remain an important and effective option for many people. When a medication does not work well enough, that does not mean medication as a whole is ineffective or that the person has exhausted every path forward.
A provider may need to consider whether the medication was taken at a therapeutic dose for an adequate period, whether side effects limited the trial, whether the diagnosis should be revisited, and whether another condition is affecting the response. The next step might involve adjusting medication, trying a different medication, adding psychotherapy, changing the therapy approach, considering a procedure-based treatment, or combining appropriate strategies.
No one should stop an antidepressant suddenly or change a dose without guidance from the prescribing clinician. Abrupt changes can cause withdrawal symptoms or worsen the underlying condition.
Our article on signs that depression may not be improving with medication discusses several reasons to ask a provider for a treatment review.
At WHOA Wellness, we do not begin by telling people that medication has failed them or that they should replace it. We begin by understanding the role previous treatments have played and determining whether another evidence-based option may be appropriate.
How TMS Treats Eligible Adults With Depression
Transcranial magnetic stimulation, or TMS, is a noninvasive brain-stimulation treatment. It uses brief magnetic pulses delivered through a coil positioned against the scalp to stimulate targeted areas of the brain involved in mood regulation.
The BrainsWay Deep TMS system used at WHOA Wellness is FDA-cleared for treating depressive episodes in adults with major depressive disorder who have not achieved satisfactory improvement from antidepressant medication during the current episode.
Unlike medication, TMS does not circulate through the bloodstream. It therefore has a different side-effect profile from antidepressants. That does not mean it has no risks or side effects.
Common effects may include temporary scalp discomfort, headache, facial-muscle contraction or tingling during treatment, lightheadedness, or dizziness. Seizure is a rare but serious potential risk. Appropriate screening, accurate dosing, and trained clinical supervision are essential.
TMS does not require anesthesia, and people can generally resume ordinary activities after a session. A course commonly involves treatment on multiple weekdays over several weeks, although the exact protocol and number of sessions depend on the device, clinical plan, and individual response.
Our overview of TMS therapy for depression explains what Richmond patients can expect from this treatment option. For a deeper look at the neuroscience behind the treatment, our article on how TMS therapy works for depression covers the underlying mechanisms in detail.
Who May Be Considered for TMS?
TMS is not automatically appropriate for everyone who feels depressed or has had a difficult experience with one medication.
A clinical evaluation typically considers:
- Whether major depressive disorder has been diagnosed
- Which antidepressants and other treatments have been tried
- Whether previous trials were adequate and well tolerated
- The severity and duration of the current episode
- Other psychiatric or medical conditions
- Current medications and substance use
- Seizure history and other neurological risk factors
- Metal or electronic implants in or near the head
- Current safety concerns, including suicide risk
People with symptoms of mania or hypomania need careful diagnostic evaluation because depressive episodes can occur as part of bipolar disorder. Treatment decisions for bipolar depression are not interchangeable with those for major depressive disorder.
Our guide to TMS candidacy offers more detail, but an online article cannot determine whether treatment is safe or suitable for a particular person.
TMS and Medication Have Different Roles
Comparing TMS and antidepressants should not become a contest in which one treatment is portrayed as good and the other as harmful.
Medication works systemically and may influence several biological pathways. TMS directs magnetic stimulation toward selected cortical targets. These differences can matter when a person has experienced medication side effects or inadequate improvement, but they do not establish that TMS is universally better.
Some people continue medication during TMS. Others also continue psychotherapy or make changes to their broader treatment plan under the guidance of their clinicians. The best approach depends on the individual.
Our discussion of TMS versus medication for depression explores these differences without suggesting that people abandon an effective or medically necessary treatment.
Whole-Person Care Does Not Mean Using Every Service
Depression can affect the body as well as mood. Fatigue, disrupted sleep, muscle tension, appetite changes, reduced activity, and difficulty maintaining routines can become part of the daily experience.
Recognizing those effects is central to our whole-person approach. However, whole-person care does not mean that every person receives TMS, massage, nutritional counseling, acupuncture, and Reiki as a standard bundle.
Each service has a different purpose and evidence base. Complementary wellness services should not be represented as substitutes for psychotherapy, medication, TMS, emergency care, or another indicated clinical treatment.
We help each person consider which services, if any, make sense alongside the rest of the care plan. A full overview of what we offer can be found on our acupuncture, massage, TMS, and medication services page.
Nutritional Counseling as Supportive Care
Nutrition and depression have a complicated relationship. Depressive symptoms can make it harder to shop, prepare food, eat regularly, or notice hunger. Medication may also affect appetite or weight.
Research suggests that dietary improvement may reduce depressive symptoms for some people, but nutrition is not a standalone cure for major depressive disorder. The evidence does not justify assuming that every person with depression has deficiencies in vitamin D, magnesium, B vitamins, omega-3 fatty acids, or another nutrient.
Rather than beginning with a predetermined list of supplements, nutritional counseling may help someone examine practical concerns such as:
- Skipping meals because of fatigue or low motivation
- Relying heavily on convenience foods because cooking feels unmanageable
- Appetite or weight changes
- High caffeine or alcohol intake
- Digestive concerns
- Dietary restrictions or medical needs
- Possible supplement and medication interactions
Our article on nutritional counseling and mental health recovery explains how this service can complement clinical care without replacing it.
Supplements can cause side effects or interact with medication. Testing, supplementation, and substantial dietary changes should be discussed with an appropriate healthcare professional.
Massage and Reiki Within Appropriate Boundaries
Massage may offer a structured opportunity to rest and address muscle tension or physical discomfort. Some research suggests possible benefits for depressive symptoms, but the evidence is limited and varies across populations and massage methods.
We do not claim that massage reliably lowers cortisol, changes neurotransmitter levels, or treats the underlying cause of major depressive disorder. Its role is better described as supportive: some people may feel temporarily more relaxed, physically comfortable, or connected to their bodies.
Our massage therapy services are customized around the client’s comfort, health history, and areas of tension. Massage may require modification or medical guidance for people with certain injuries, infections, clotting concerns, recent procedures, pregnancy, or other health conditions.
Reiki is an optional wellness practice involving light touch or hands held just above the body. It has not been clearly shown to treat depression or another health condition, and the proposed energy field associated with Reiki has not been scientifically established.
Some people nevertheless describe Reiki sessions as quiet, calming, or personally meaningful. We can respect that subjective experience without presenting Reiki as a proven treatment for depression. It should never delay necessary mental health or medical care. To learn more about how Reiki fits within a broader mental wellness context, see our post on Reiki healing for mental wellness in RVA.
Insurance Coverage Depends on the Individual Plan
Many insurance plans cover TMS for eligible patients with major depressive disorder, but coverage is never automatic.
WHOA Wellness currently works with plans including Aetna, UnitedHealthcare, Cigna, Medicare, many Medicaid plans, and Anthem. Each insurer may apply its own medical-necessity criteria, documentation requirements, network rules, and prior-authorization process.
Requirements may include a confirmed diagnosis, records of previous medication trials, documentation of psychotherapy, or other clinical information. Even within the same insurance company, benefits can differ between plans.
Our team verifies benefits and discusses known out-of-pocket costs before treatment begins. Patients should not assume that general participation with an insurer guarantees coverage under their specific policy. For a fuller explanation of how insurance authorization typically works, our post on whether TMS therapy is covered by insurance walks through the process in detail.
Making Treatment More Manageable
Depression often makes the practical steps of seeking care feel harder. Phone calls, paperwork, transportation, scheduling, and insurance questions can become significant barriers when energy and concentration are already limited.
Our appointment-only model is designed to provide focused, unhurried care. During an initial conversation, we review what the person is experiencing, what has been tried, and whether our services appear to fit.
A responsible plan may involve TMS, a complementary wellness service, continued care with existing providers, or a referral elsewhere. We do not want the availability of several services to create pressure to use all of them.
The goal is not to make treatment another test you have to pass. It is to identify a realistic next step and build from there. If you are ready to take that step, contact us to schedule a consultation with our team.
Frequently Asked Questions
Is TMS covered by insurance for depression in Richmond, VA?
Many plans cover TMS for people who meet their medical-necessity criteria. WHOA Wellness works with Aetna, UnitedHealthcare, Cigna, Medicare, many Medicaid plans, and Anthem.
Coverage varies by policy. Prior authorization and documentation of previous treatment are commonly required, so our team verifies the individual plan before treatment begins.
How is TMS different from antidepressant medication?
Antidepressants circulate through the body and influence biological systems associated with mood. TMS uses magnetic pulses to stimulate targeted areas of the brain from outside the head.
Because the treatments work differently, their side effects and candidacy requirements also differ. TMS is not free of risk, and it is not automatically preferable to medication. A provider should help determine which option or combination is appropriate.
What does whole-person depression care include at WHOA Wellness?
Our confirmed services include TMS, nutritional counseling, acupuncture, massage therapy, and Reiki. We select services according to the person’s clinical needs, preferences, health history, and goals.
Complementary services are supportive. They are not replacements for indicated psychotherapy, medication, medical care, or crisis intervention.
What if I have already tried several antidepressants?
Multiple inadequate medication responses may be one reason to discuss TMS, but medication history is only part of the evaluation.
We also consider diagnosis, previous psychotherapy, current symptoms, medical and psychiatric history, safety factors, and whether another explanation for the symptoms should be explored.
How long does TMS take to work?
There is no universal timeline. Treatment is commonly scheduled on multiple weekdays over several weeks, and improvement may occur gradually.
Some people improve during the initial course, while others respond later or do not experience adequate benefit. The treating clinician should discuss progress, expectations, and next steps throughout care.
Key Takeaways
- An incomplete response to antidepressant medication is not a personal failure.
- Depression can affect mood, concentration, sleep, appetite, energy, relationships, and physical well-being.
- The BrainsWay Deep TMS system is FDA-cleared for eligible adults with major depressive disorder who did not achieve satisfactory improvement from antidepressant medication during the current episode.
- TMS does not require anesthesia, but it has potential side effects and requires clinical screening.
- Insurance coverage depends on the person’s specific plan, clinical criteria, and prior-authorization requirements.
- Nutritional counseling, massage, and Reiki have supportive roles and should not be promoted as replacements for evidence-based depression treatment.
- Whole-person care means matching services to the individual—not automatically combining every available modality.
When the Previous Plan Has Not Been Enough
Living with depression in Richmond, VA, after medication has not provided sufficient relief can make hope feel difficult to access. A disappointing response does not mean you have failed, and it does not necessarily mean you have exhausted your options.
At WHOA Wellness, we offer FDA-cleared TMS for eligible adults with major depressive disorder and complementary wellness services that may support selected aspects of care. We begin by reviewing your history, symptoms, previous treatment, and goals rather than making assumptions about what you need.
The next plan may look different from the last one. What matters is that it is clinically appropriate, clearly explained, and built with realistic expectations.
About the WHOA Wellness Team
At WHOA Wellness in Richmond, VA, our team brings clinical treatment and complementary wellness services together in an appointment-only environment.
We recognize that depression can affect the whole person—body and mind. Our approach respects the distinct roles of TMS, psychotherapy, medication, nutritional counseling, acupuncture, massage, Reiki, medical care, and community support. We meet people where they are while maintaining clear boundaries around what each service can and cannot provide.
Works Cited
National Institute of Mental Health. (n.d.). https://www.nimh.nih.gov/health/statistics/major-depression. National Institutes of Health.
National Institute of Mental Health. (n.d.). https://www.nimh.nih.gov/health/publications/depression. National Institutes of Health.
U.S. Food and Drug Administration. (2024). https://www.accessdata.fda.gov/cdrh_docs/pdf22/K222196.pdf.
Department of Veterans Affairs & Department of Defense. (2022). https://www.healthquality.va.gov/guidelines/MH/mdd/VADODMDDCPGFinal508.pdf.
National Institute of Mental Health. (n.d.). https://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies. National Institutes of Health.
Firth, J., Marx, W., Dash, S., Carney, R., Teasdale, S. B., Solmi, M., Stubbs, B., Schuch, F. B., Carvalho, A. F., Jacka, F., & Sarris, J. (2019). https://pubmed.ncbi.nlm.nih.gov/30720698/. Psychosomatic Medicine, 81(3), 265–280.
National Center for Complementary and Integrative Health. (n.d.). https://www.nccih.nih.gov/health/massage-therapy-what-you-need-to-know. National Institutes of Health.
National Center for Complementary and Integrative Health. (n.d.). https://www.nccih.nih.gov/health/reiki. National Institutes of Health.
Medical Disclaimer
The information in this blog is provided for educational purposes only and does not constitute medical advice, diagnosis, or a treatment recommendation. Do not stop or change medication without consulting the prescribing clinician. TMS and complementary wellness services may not be appropriate for everyone, and no outcome is guaranteed.
Anyone experiencing thoughts of suicide or self-harm should call or text 988 to reach the 988 Suicide & Crisis Lifeline. Call 911 or seek emergency care when there is immediate danger.