If depression has continued despite treatment, or medication side effects have made it hard to continue, you may be wondering whether there is another path. Transcranial Magnetic Stimulation (TMS) is a noninvasive treatment that uses magnetic pulses to stimulate brain circuits involved in mood. It may be an option for some adults with major depressive disorder, including people with treatment-resistant depression.
At Light-tunnel Behavioral Health Services Inc. in New Haven, psychiatric providers, including Dr. Omolola Aragbada, PMHNP-BC, can help you review your symptoms, treatment history, preferences, and safety needs. TMS is not the best fit for everyone, and needing to consider another option does not mean you have failed. It means your care may need a different approach.
What does “treatment-resistant depression” mean?
The term usually describes depression that has not improved enough after one or more appropriate treatment attempts. The exact definition can vary across clinical settings and insurance policies. Your clinician may consider the medication, dose, duration, your response, side effects, and whether the diagnosis or treatment plan needs another look.
Depression can affect brain networks involved in motivation, attention, sleep, and emotional regulation. One everyday way to picture this is as a set of communication routes: when some routes are underactive, messages may not travel as effectively. TMS aims to stimulate selected areas of the brain. Researchers continue to study precisely how that stimulation leads to symptom improvement.
Who may be a good candidate for TMS therapy?
TMS may be worth discussing if you:
- Have been diagnosed with major depressive disorder and symptoms are still affecting daily life.
- Have had limited benefit from antidepressants, or have found medication side effects difficult to tolerate.
- Prefer to consider a noninvasive, non-medication treatment.
- Can attend frequent appointments over a treatment course that typically lasts several weeks.
- Have been assessed for medical and psychiatric factors that may affect safety or treatment choice.
A TMS evaluation is not just a count of medications tried. Your provider should review your diagnosis, current symptoms, past treatment response, medications, medical history, and safety concerns. Screening may include questions about seizure history and implanted devices or metal near the head. These factors do not all automatically rule out TMS, but they need careful individual review.
Medication-resistant and medication-intolerant are not the same. If a medication did not help despite an adequate trial, that is different from stopping it because of significant side effects. Both experiences matter when your provider considers options. However, coverage rules and authorization criteria vary, so intolerance alone may not guarantee insurance approval.
BrainsWay and the research behind Deep TMS
BrainsWay Deep TMS is one of the most researched TMS systems. In a multicenter randomized, sham-controlled trial of adults with major depression, active Deep TMS produced greater improvement in depression symptoms than sham treatment; response and remission rates were also higher in the active-treatment group (Levkovitz et al., 2015). Results from a clinical trial describe outcomes across a study group, not a promise of how any one person will respond.
TMS session length depends on the system and protocol. Many sessions take about 20–40 minutes, while some protocols may take as little as three minutes. A shorter session does not necessarily mean a shorter overall treatment course: appointments are commonly frequent over several weeks. Ask your provider which protocol is being considered, how long visits will take, and what schedule applies to you. You can learn more about TMS therapy for treatment-resistant depression and OCD.
TMS, Spravato, therapy, or medication management: how do options compare?
These treatments are not always either-or choices. Your care plan may include more than one, depending on your needs and clinical assessment.
| Option | May suit you if… | Practical considerations |
|---|---|---|
| TMS | You want to explore a noninvasive treatment, or medication has not helped enough or has been difficult to tolerate. | Requires repeated clinic visits. Session length depends on protocol; a clinician must assess your safety and eligibility. |
| Spravato (esketamine) | You and your psychiatric provider decide a supervised medication treatment is appropriate for your depression. | It is administered in a certified setting and requires monitoring after each dose. A randomized trial found greater improvement in depressive symptoms with esketamine plus a newly initiated oral antidepressant than with the comparison treatment over four weeks (Popova et al., 2019). |
| Therapy | You want support with coping skills, patterns of thinking, relationships, stressors, or emotional processing. | Therapy can be used on its own or alongside other treatment. The right approach and pace depend on your goals and circumstances. |
| Medication management | You want a careful review of medication choices, benefits, side effects, or adjustments. | Medication decisions should be made with a prescriber; do not stop or change a prescription on your own. |
There is no single best depression treatment for everyone. Although TMS and Spravato can both be considered for some people with difficult-to-treat depression, their methods, visit requirements, risks, and eligibility criteria differ. This comparison is not a head-to-head trial or a recommendation to choose one without a clinician’s guidance.
What might make another option a better fit?
TMS may be less practical if frequent appointments are difficult to attend, or if a safety concern has not yet been evaluated. A different treatment may be more appropriate if you need a level of support that outpatient care cannot provide, have symptoms needing urgent assessment, or have a diagnosis that calls for a different treatment plan.
Spravato may involve different medical precautions and requires supervised administration and post-dose monitoring. Therapy or medication management may be important whether or not you pursue TMS. Your clinician can help weigh your schedule, preferences, health history, prior treatment experiences, and goals, not just the name of a treatment.
What to ask at a TMS consultation
Consider bringing a list of medications and past treatments, including how long you tried each one and what benefits or side effects you noticed. You may also want to ask:
- Which TMS protocol is being considered, and how long is each session?
- How many visits per week and for how many weeks?
- What side effects should I expect, and what should I report?
- Are any of my medical conditions, medications, or devices relevant to safety?
- What are the clinical and insurance criteria for my situation?
- What alternatives (including Spravato, therapy, or medication management) should I consider?
TMS treatment in New Haven: insurance and self-pay questions
If you are considering TMS treatment in New Haven, ask the clinic to explain the evaluation process, likely visit schedule, and how coverage is checked. Approval requirements can differ by insurer and plan, so it is sensible to confirm details before starting.
If you are a self-pay client, you can still ask Light-tunnel Behavioral Health Services Inc. about an evaluation and available services. A provider can help you understand whether TMS or another option may be clinically appropriate; the practice can explain fees, payment expectations, and any available self-pay arrangements directly. You do not need to decide on a treatment before speaking with a psychiatric provider. You can also explore medication management, psychotherapy, or schedule an appointment.
A hopeful next step
If depression has been stubborn, it makes sense to feel tired or uncertain about trying something new. TMS is one of several depression treatment options that may help some people, but a thoughtful evaluation is the first step. Together, you and your care team can compare potential benefits, practical demands, risks, and personal preferences, and build a plan that fits your needs.
Medical safety disclaimer and crisis resources
This article is for educational purposes only. It does not provide a diagnosis or replace advice from a qualified healthcare professional. TMS is not appropriate for everyone; a psychiatric provider must evaluate your individual circumstances. Do not stop or change medication without guidance from your prescriber.
If you are thinking about suicide, feel unable to stay safe, or are worried about someone else, call or text 988 in the United States to reach the Suicide & Crisis Lifeline. If there is immediate danger or a medical emergency, call 911 or go to the nearest emergency department.
References
- Levkovitz Y, Isserles M, Padberg F, et al. Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry. 2015;14(1):64–73. doi:10.1002/wps.20199
- Popova V, Daly EJ, Trivedi M, et al. Efficacy and safety of flexibly dosed esketamine nasal spray combined with a newly initiated oral antidepressant in treatment-resistant depression: a randomized double-blind active-controlled study. American Journal of Psychiatry. 2019;176(6):428–438. doi:10.1176/appi.ajp.2019.19020172
- BrainsWay. How long does Deep TMS treatment take?
Continue the Series
Next, read our Spravato guide: What to Expect During Spravato Treatment.