When depression continues despite adequate medication trials, you may feel as though your brain’s recovery system is stuck in low gear. That experience is real, and it is not a personal failure. Treatment-resistant depression (TRD) often requires a more individualized strategy than simply trying the next medication.
For patients in New Haven, the key question may be: Should you continue adjusting antidepressants, consider TMS therapy, or combine approaches?
At Light-tunnel Behavioral Health Services Inc., psychiatric providers including Dr. Omolola Aragbada, PMHNP-BC, evaluate your symptoms, treatment history, medical factors, and preferences before recommending a plan. This guide compares TMS therapy, antidepressants, and combined care without assuming that one option is right for everyone.
TMS vs. Antidepressants vs. Combined Care: Quick Comparison
| Treatment factor | TMS therapy | Antidepressant medication | Combined care |
|---|---|---|---|
| Primary mechanism | Uses magnetic pulses to modulate activity in depression-related brain circuits, often involving the dorsolateral prefrontal cortex | Changes neurotransmitter signaling through medications such as SSRIs, SNRIs, atypical antidepressants, or other classes | Addresses brain-circuit activity, neurotransmitter signaling, behavior, and psychological factors together |
| Typical time to response | Often develops over several weeks of frequent sessions; some patients improve gradually | Commonly requires several weeks after starting or adjusting medication | May provide multiple opportunities for improvement, but each component has its own timeline |
| Durability | Some responders maintain benefits; continuation or maintenance sessions may be recommended | Benefits may continue while medication is effective and taken consistently; relapse-prevention plans vary | May support durability through medication, therapy skills, lifestyle changes, and planned maintenance |
| Common side effects | Scalp discomfort, tapping sensations, headache, or facial muscle twitching; serious complications are uncommon but screening is essential | Nausea, sleep changes, sexual side effects, emotional blunting, weight changes, activation, or withdrawal symptoms can occur depending on the medication | Side effects depend on the medication and TMS protocol |
| Monitoring burden | Frequent visits and symptom monitoring during the acute course | Medication follow-ups, dose adjustments, safety monitoring, and adherence checks | Monitoring is more involved because several treatments are coordinated |
| Lifestyle burden | Often daily weekday visits during acute treatment; sessions may last approximately 20–40 minutes depending on the system and settings, with some distinct protocols lasting about 3 minutes | Usually easier to fit into a daily routine, but requires consistent dosing and appointments | Requires coordinating visits, medication routines, and possibly therapy |
| May suit | People who have not improved sufficiently with medication, cannot tolerate medication side effects, or prefer a non-systemic treatment option | People who have responded to medication before, prefer a home-based daily treatment, or are not candidates for TMS | People who need a layered strategy for persistent, recurrent, or complex depression |
How TMS and Antidepressants Work Differently
Antidepressants work throughout the body. Depending on the medication, they influence serotonin, norepinephrine, dopamine, glutamate, or related signaling pathways. You can think of medication as adjusting the chemical “messengers” that help brain cells communicate.
TMS works more like targeted circuit training. Repeated magnetic stimulation may help regulate activity and connectivity in brain networks involved in mood, motivation, attention, and emotional processing. BrainsWay Deep TMS is one of the most extensively researched Deep TMS systems, using an H-coil designed to stimulate broader and deeper regions than conventional figure-eight-coil rTMS.
The treatment is noninvasive and does not require anesthesia. A typical BrainsWay Deep TMS session is approximately 20 minutes. Conventional rTMS sessions may take closer to 40 minutes, while intermittent theta-burst stimulation, or iTBS, may use a distinct protocol lasting about 3 minutes. These shorter protocols are not simply the same treatment compressed; your clinician should explain the specific protocol, evidence, and expected schedule.
Which Works Faster: TMS or Medication?
Antidepressants often require several weeks at an adequate dose before your clinician can determine whether they are helping. If the first medication is ineffective or poorly tolerated, the process may take longer because another medication, dose, or combination must be tried.
TMS is also not an instant treatment. Acute courses commonly involve weekday sessions for approximately four to six weeks, although schedules vary. Some people notice early changes in energy, sleep, or concentration; others improve more gradually.
In a randomized controlled trial of adults who had not responded adequately to at least two prior treatment trials, rTMS produced higher response and remission rates than switching or augmenting antidepressant treatment: response was 37.5% versus 14.6%, and remission was 27.1% versus 4.9% after eight weeks (Dalhuisen et al., 2024). This study supports rTMS as a reasonable next step for some patients, but it does not mean every person will respond or that every TMS device and protocol has identical results.
Side Effects and Monitoring: A Practical Contrast
Antidepressants
Medication side effects may be mild and temporary, or they may persist long enough to affect quality of life. Depending on the medication, your clinician may monitor:
- Sleep, appetite, weight, and energy
- Sexual functioning
- Anxiety, agitation, or mood activation
- Blood pressure or heart rate
- Suicidal thoughts, especially after starting or changing medication
- Symptoms of mania or hypomania if bipolar disorder is possible
Never stop an antidepressant suddenly without medical guidance. Some medications can cause discontinuation symptoms.
TMS Therapy
TMS side effects are usually localized. You may experience scalp tenderness, a tapping sensation, headache, or jaw or facial muscle discomfort during early sessions. A thorough evaluation is important because seizure risk, implanted metal or electronic devices, and certain neurological conditions may affect eligibility.
TMS generally does not cause the whole-body side effects associated with many medications, and patients typically return to normal activities immediately afterward. However, “noninvasive” does not mean “appropriate for everyone.” Screening and individualized monitoring remain essential.
Acute Treatment vs. Maintenance Treatment
The acute phase is designed to reduce current depressive symptoms.
- TMS acute care: Often involves frequent sessions, commonly five days per week, for several weeks.
- Medication acute care: Involves starting, switching, or titrating medication and allowing enough time to assess response.
- Combined acute care: May include TMS while continuing medication and adding therapy or behavioral support.
The maintenance phase is designed to reduce relapse risk after improvement.
- TMS maintenance: May involve tapering, periodic booster sessions, or twice-weekly treatment for a defined continuation period. There is no single universally accepted schedule.
- Medication maintenance: Often means continuing an effective medication for a period recommended by your psychiatric provider, sometimes longer when depression is recurrent or severe.
- Combined maintenance: May include medication, psychotherapy, symptom tracking, lifestyle supports, and occasional TMS sessions.
In a multicenter randomized trial of BrainsWay Deep TMS for depression, active treatment outperformed sham treatment during the acute phase, and the difference remained stable during a subsequent 12-week maintenance phase (Levkovitz et al., 2015). This supports planned continuation care, but it does not guarantee permanent protection from relapse.
Where Therapy and Interventional Psychiatry Fit
Depression treatment is not limited to a choice between a machine and a pill.
At Light-tunnel Behavioral Health Services Inc., a broader plan may include:
- Psychotherapy: CBT, DBT-informed care, behavioral activation, coping skills, and work on negative thought patterns
- Medication management: Choosing medications, adjusting doses, monitoring side effects, and evaluating interactions or diagnostic changes
- Interventional psychiatry: Treatment approaches such as TMS or esketamine/Spravato evaluation when standard approaches have not provided enough relief
- Psychiatric evaluation: Clarifying whether symptoms reflect unipolar depression, bipolar depression, trauma-related symptoms, substance effects, medical illness, or another condition
Medication management is primarily a prescribing and monitoring process. Interventional care adds a procedure-based treatment, such as TMS, that directly targets brain circuits. Therapy focuses on behavior, cognition, relationships, emotional regulation, and meaning. These services can be alternatives in some situations, but they are often most useful when coordinated.
Who May Benefit Most From Each Option?
Medication may be a reasonable fit if you:
- Have previously responded well to antidepressants
- Prefer a treatment that does not require frequent office visits
- Are comfortable with ongoing medication monitoring
- Are not currently eligible for TMS
TMS may be worth discussing if you:
- Have had inadequate improvement after appropriate antidepressant trials
- Have medication side effects that are difficult to tolerate
- Prefer a noninvasive, non-sedating treatment
- Can attend frequent sessions during the acute phase
Combined care may be especially appropriate if you:
- Have persistent or recurrent depression
- Need symptom relief plus relapse-prevention skills
- Have co-occurring anxiety, trauma symptoms, or functional impairment
- Want medication, therapy, and interventional options coordinated through one treatment plan
Self-Pay Care in New Haven
Self-pay clients can benefit from the same individualized clinical planning even when insurance is not being used. At Light-tunnel Behavioral Health Services Inc., self-pay care may include:
- A psychiatric evaluation
- Medication management
- Individual therapy
- TMS evaluation and treatment planning
- Transparent fee information before services begin
- Flexible payment discussions, including sliding-scale availability when applicable
- Superbills for possible out-of-network reimbursement
- Fewer insurance authorization delays when choosing a self-pay pathway
Review the practice’s services, accepted insurance plans, or contact Light-tunnel Behavioral Health Services Inc. to ask about current fees, eligibility, and scheduling in New Haven.
The Bottom Line
For treatment-resistant depression, the choice is not always “TMS or antidepressants.” The most appropriate plan may be medication, TMS, therapy, or a carefully coordinated combination.
A psychiatric evaluation with Dr. Omolola Aragbada, PMHNP-BC, or another qualified provider can help clarify what has already been tried, whether the diagnosis needs review, what risks require monitoring, and whether an acute or maintenance strategy makes sense for you.
Depression can make the future feel permanently closed off. It is not. Treatment may require adjustment, patience, and more than one tool, but meaningful improvement remains possible.
Medical Safety Disclaimer
This article is for educational purposes and does not replace a personalized evaluation, diagnosis, or treatment plan from a qualified healthcare professional. Do not start, stop, or change psychiatric medication without medical guidance. TMS and other interventional treatments require appropriate screening.
If you may hurt yourself or someone else, call 911 or go to the nearest emergency department. If you are experiencing suicidal thoughts or a mental health crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline. You deserve immediate support.
References
- Dalhuisen, I., et al. “rTMS as a Next Step in Antidepressant Nonresponders: A Randomized Comparison With Current Antidepressant Treatment Approaches.” American Journal of Psychiatry, 2024;181(9):806–814. PubMed
- Levkovitz, Y., et al. “Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Major Depression: A Prospective Multicenter Randomized Controlled Trial.” World Psychiatry, 2015. Study PDF
- BrainsWay. Deep TMS Treatment for Major Depressive Disorder
- BrainsWay. What Happens During a Deep TMS Procedure?
Continue the Series
Next: Ketamine vs. Esketamine (Spravato): What’s the Difference? A New Haven Guide to Depression Treatment