The question most people ask when they first hear about TMS therapy is some version of this: is it better than antidepressants? It’s the wrong question — but it’s an understandable one. The more useful frame is: which depression treatment is more appropriate for this person, given their history, their biology, and what they’ve already tried? At WHOA Wellness in Richmond, VA, that question drives every TMS consultation we conduct. Antidepressants and TMS are not competing products. They are different tools for a condition that doesn’t respond identically across individuals.
How Antidepressants Work
Antidepressant medications — particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), the two most commonly prescribed classes — work by increasing the availability of specific neurotransmitters in the brain (PMC; PMC). SSRIs slow the reabsorption of serotonin, leaving more of it active in the synaptic space between neurons. SNRIs do the same for both serotonin and norepinephrine. The underlying theory is that increasing the availability of these neurotransmitters restores more normal signaling in the circuits involved in mood regulation.
For a significant portion of people with major depressive disorder, this mechanism produces meaningful relief. Antidepressants are effective, well-studied, and widely accessible — and for patients whose depression responds to them, they remain a cornerstone of treatment. The complication arises for the roughly one in three patients whose depression doesn’t respond adequately to one or more antidepressant trials, or who experience side effects that make sustained use difficult.
Common side effects associated with SSRIs and SNRIs include weight gain, sexual dysfunction, emotional blunting, gastrointestinal disruption, and sleep changes (PMC). For some patients, these effects are manageable. For others, they are the reason treatment gets discontinued before it has a real chance to work — or the reason a technically effective medication becomes practically unusable.
How TMS Works
TMS — transcranial magnetic stimulation — takes a different approach entirely. Rather than altering neurotransmitter levels throughout the brain and body, TMS delivers focused magnetic pulses directly to the left dorsolateral prefrontal cortex, the brain region most consistently underactive in patients with major depressive disorder. Those pulses stimulate the neurons in the targeted area to fire more regularly, gradually strengthening the neural pathways involved in mood regulation through a process called neuroplasticity — the brain’s capacity to form and reinforce new connections (Mayo Clinic).
A standard course of TMS therapy at WHOA Wellness runs 30 to 36 sessions over six to eight weeks, scheduled five days per week. Sessions last 20 to 40 minutes. No anesthesia. No sedation. No systemic side effects — because TMS works locally on a defined brain region rather than altering chemistry throughout the entire body. The most common side effects are temporary scalp discomfort or a mild headache in early sessions, both of which typically resolve within the first week (National Institute of Mental Health). Seizures are an extremely rare risk, occurring in less than 0.01% of sessions.
At WHOA Wellness, we use Brainsway Deep TMS technology, which reaches deeper brain structures and covers a broader stimulation area per pulse than standard TMS devices — increasing the cumulative effect of each session and reducing the chance of subtherapeutic targeting. You can find a detailed breakdown of what to expect on our TMS therapy facts page.
The Core Differences
The practical differences between the two approaches come down to mechanism, side effect profile, time commitment, and patient candidacy.
Antidepressants are systemic — they circulate through the entire body and affect neurotransmitter function broadly. TMS is local — it acts on a defined brain region without producing systemic effects. That distinction matters most to patients who have struggled with medication side effects, who have medical conditions that complicate systemic medication use, or who simply prefer a treatment that doesn’t require daily pills with ongoing physiological effects.
The time commitment differs as well. Antidepressants require daily administration and typically four to eight weeks before their therapeutic effect can be evaluated — and then ongoing use to maintain those effects. TMS requires a defined course of in-office sessions over six to eight weeks, after which many patients maintain their improvement without ongoing treatment. Some patients eventually need a booster course if symptoms begin to return, but the treatment is not indefinitely continuous in the way daily medication is.
Candidacy is the most important differentiator. TMS is FDA-cleared specifically for adults with major depressive disorder who have not achieved satisfactory improvement from prior antidepressant medications. It is not typically the first treatment recommended for someone newly diagnosed with depression who has never tried medication. It is the treatment that becomes most clearly indicated when medication trials haven’t produced the relief patients need.
What the Evidence Supports
Peer-reviewed research confirms that TMS produces meaningful antidepressant effects in patients who have not responded to prior medication trials, with its FDA clearance based on rigorous clinical data demonstrating both efficacy and safety (Mayo Clinic; PMC). The evidence base for antidepressants is similarly well-established for the broader population of patients with major depressive disorder (PMC).
The question of which treatment produces better outcomes in absolute terms is less clinically useful than the question of which produces better outcomes for a specific patient profile. For patients without prior medication trials, antidepressants remain the established first-line approach. For patients with documented inadequate response to at least one antidepressant at therapeutic doses — and particularly for those who’ve tried multiple medications — TMS offers a different mechanism with a strong evidence base and no systemic side effect burden. Our page on TMS for depression covers this in greater depth.
Results vary by individual, and neither treatment guarantees remission. The goal is finding the approach most likely to work given what your history tells us about the nature of your depression.
Can TMS and Medication Be Used Together?
Yes, and frequently are. Many patients receive TMS while continuing their existing antidepressant medications. As TMS begins to produce improvement, some patients work with their prescribing provider to reassess their medication plan — reducing doses, simplifying their regimen, or discontinuing medications they’ve been on for years without adequate benefit. Others continue their medications unchanged throughout and after TMS, finding that the combination produces better results than either alone.
These decisions are made collaboratively with your prescribing provider, not unilaterally. We coordinate with outside providers throughout your TMS course at WHOA Wellness. No medication changes should be made without discussing them with the provider who prescribed them.
Making the Decision
The practical starting point is your treatment history. If you’ve tried one or more antidepressants at adequate doses for adequate duration without sufficient improvement, TMS is worth a serious conversation. If medication side effects have made sustained use difficult or impossible, TMS is worth exploring. If you’ve achieved partial improvement on medication but still struggle to function at the level you want, that partial response is its own clinical signal.
At WHOA Wellness, our consultation process is designed to give you a clear, direct assessment of whether TMS is appropriate for your specific situation. We review your full medication and treatment history, confirm candidacy, verify insurance coverage, and explain exactly what a treatment course would involve. Most major insurance plans — including Aetna, United Healthcare, Cigna, Medicare, Anthem, and many Medicaid plans — cover TMS for qualified patients. We handle prior authorization before treatment begins.
Explore your options, ask specific questions about what the evidence says for your presentation, and discuss any treatment decision with your provider before proceeding. The goal is a plan built on your actual history — not a default toward whatever approach is most familiar.
Frequently Asked Questions
If antidepressants partially helped me, should I still consider TMS? Partial response is a legitimate clinical signal that your current approach isn’t fully addressing the biology of your depression. Many patients who achieved some improvement on antidepressants but still struggle with persistent symptoms find that TMS addresses what medication left unresolved. A consultation at WHOA Wellness can help clarify whether your history suggests TMS is worth pursuing.
Do I have to stop my antidepressant to start TMS? No. Many patients receive TMS while continuing their current medications. Whether to adjust or maintain your medication during TMS is a decision made with your prescribing provider based on your specific situation.
What if I’ve only tried one antidepressant? TMS is FDA-cleared for patients who haven’t achieved satisfactory improvement from prior antidepressant medications. Coverage criteria for insurance typically require documentation of at least one to two failed trials, depending on the plan. If you’ve tried one medication without adequate relief, that history is worth reviewing during a consultation to determine whether you meet candidacy and coverage criteria.
How long do TMS results last compared to antidepressants? Many patients maintain their TMS results for months or longer after completing their treatment course, without ongoing sessions. Some eventually need a booster course if symptoms begin to return. Antidepressants, by contrast, typically require ongoing daily use to maintain their effects. Individual response to both treatments varies significantly.
What if neither TMS nor medication has worked for me? If you have tried multiple antidepressants and a full course of TMS without adequate relief, that history warrants a thorough clinical review. We discuss your full picture honestly during consultation, including what options have and haven’t been exhausted. We don’t guarantee outcomes — no ethical provider can — but we do give you a direct assessment of what the next steps might reasonably look like.
Key Takeaways
- Antidepressants work by altering neurotransmitter availability systemically throughout the brain and body; TMS works by directly stimulating underactive brain circuits locally, through a non-invasive, externally applied magnetic field.
- TMS produces no systemic side effects — no weight gain, no sexual dysfunction, no cognitive dulling — because it acts on a defined brain region rather than the whole body.
- TMS is FDA-cleared for patients with major depressive disorder who have not achieved satisfactory improvement from prior antidepressant medications — it is most clearly indicated when medication hasn’t been sufficient.
- TMS and antidepressants can be used simultaneously; medication decisions during TMS should always be made collaboratively with your prescribing provider.
- Results vary by individual; the right treatment depends on your specific history, biology, and what prior trials have shown about how your depression responds.
The decision between TMS and medication isn’t about which is universally better — it’s about which is more appropriate for where you are in your treatment history. At WHOA Wellness in Richmond, VA, we help you make that determination based on your actual situation. Request a consultation with our team to review your history, confirm candidacy, and get a clear picture of what TMS therapy would involve.
References
- Mayo Clinic. Transcranial magnetic stimulation. https://www.mayoclinic.org/tests-procedures/transcranial-magnetic-stimulation/about/pac-20384625
- PMC. Selective serotonin reuptake inhibitors (SSRIs). https://pmc.ncbi.nlm.nih.gov/articles/PMC8395812/
- PMC. Serotonin-norepinephrine reuptake inhibitors (SNRIs). https://pmc.ncbi.nlm.nih.gov/articles/PMC8544373/
- National Institute of Mental Health. Transcranial magnetic stimulation — safety and risk. https://www.nimh.nih.gov/news/media/2020/sarah-h-lisanby-transcranial-magnetic-stimulation-safety-and-risk
- PMC. TMS FDA approval — general. https://pmc.ncbi.nlm.nih.gov/articles/PMC8864803/
Medical Disclaimer
The information in this blog is for educational purposes only and does not constitute medical advice. Decisions about antidepressant medications, TMS therapy, or any other treatment for depression should only be made under the supervision of a licensed provider familiar with your full medical and psychiatric history. Do not adjust or discontinue medications without consulting your prescribing provider. Individual results vary. If you are experiencing a mental health crisis or thoughts of self-harm, please call or text 988 to reach the Suicide and Crisis Lifeline or go to your nearest emergency room.