David Garcia
Depression is one of the most common health conditions in the United States, and medication has long been the default first response. An estimated 21 million adults, or 8.3 percent of the adult population, had at least one major depressive episode in 2021 (National Institute of Mental Health). Yet a large share of those patients do not reach remission on medication alone, and many stop taking it early.
How well do antidepressants work for most patients?
Antidepressants help many patients, but the first medication often falls short. In the largest real-world study of depression treatment, only about one-third of patients reached remission with their first antidepressant (American Journal of Psychiatry). Patients who do not respond often move through several medication trials, each taking weeks to evaluate.
Why do patients stop taking antidepressants?
Patients stop taking antidepressants for several reasons, including side effects, slow results, and concerns about long-term use. One national analysis found that more than 4 in 10 patients discontinued antidepressant treatment within the first 30 days (American Journal of Psychiatry). Early discontinuation leaves symptoms untreated and often discourages patients from seeking further care.
What is transcranial magnetic stimulation?
Transcranial magnetic stimulation is a noninvasive treatment that uses magnetic pulses to stimulate brain regions involved in mood regulation. It does not require anesthesia or medication, and patients typically return to normal activities immediately after each session. Deep TMS uses a specialized coil to reach broader and deeper areas of the brain, and outpatient practices in the St. Louis region now offer it using BrainsWay technology at locations in St. Louis, Missouri, and O’Fallon, Illinois (Lakeside Behavioral Health).
When did regulators clear TMS?
Federal regulators first cleared a TMS device for major depressive disorder in 2008, and a deep TMS system received clearance for depression in 2013 (Food and Drug Administration). Since then, TMS has become an established option for adults whose depression has not improved with medication.
What does a typical TMS course look like?
A typical course involves sessions five days a week for several weeks. Each session lasts a short time, and patients remain awake and alert, so many continue working and driving throughout treatment.
Who is a good candidate for non-medication treatment?
Good candidates for non-medication treatment often share certain experiences:
- Little or no improvement after one or more antidepressant trials
- Side effects that made medication difficult to continue
- A preference to avoid daily medication when possible
- Demanding jobs that make sedating side effects a concern
How does therapy fit with TMS?
Therapy fits alongside TMS by helping patients build skills while their symptoms improve. Approaches such as cognitive behavioral therapy and dialectical behavior therapy give patients tools to manage stress, change thought patterns, and sustain progress after treatment ends.
Is medication still part of the picture?
Medication remains a valid option for many people, and the right plan depends on each patient’s history, symptoms, and goals. The key shift is that patients now have effective alternatives when medication does not work or is not the right fit, rather than cycling through prescriptions with limited results.
How do patients know if treatment is working?
Patients and providers track progress with standardized symptom questionnaires taken before, during, and after treatment. These measures show changes in mood, sleep, energy, and concentration over time. Regular check-ins also give providers a chance to adjust the plan if progress is slower than expected.
How long do results last?
Many patients maintain improvement after completing a course of treatment, especially when they continue therapy and build healthy routines. Some return for maintenance sessions if symptoms begin to return, which is often easier than starting a new medication trial.
What should patients and families take away?
Depression treatment is no longer limited to choosing the next prescription. Patients who have struggled with medication can talk with a mental health provider about non-medication options such as deep TMS and evidence-based therapy, which offer real paths to recovery with fewer of the trade-offs that lead many people to stop treatment.
