Depression can make every next step feel heavier than it should. When you have taken medication consistently, attended appointments, and still do not feel like yourself, it is understandable to wonder what comes next.
At HavenNexus Advanced Psychiatry & TMS, we believe an inadequate medication response should lead to a thoughtful conversation, not self-blame. Depression is not a personal failure. Needing a different approach does not mean you have run out of options. For some people, TMS therapy for depression may become one part of a broader care plan.
When medication has not brought enough relief
Antidepressants can be helpful, but they do not work the same way for every person. Some people have partial improvement. Others have side effects that are hard to manage. Symptoms may also return despite treatment.
One medication that did not help does not automatically mean treatment-resistant depression. We look at the medication type, dose, length of treatment, consistency, and prior attempts. We also consider your diagnosis, health history, current symptoms, and daily life.
A recent review of treatment-resistant depression notes that identifying treatment resistance takes more than counting medication trials (McIntyre et al., 2023). The burden can include lost time, strained relationships, and difficulty meeting everyday responsibilities, as described in research on its personal and clinical impact (Touloumis, 2021).
The question is not, “Why have I failed treatment?” A more useful question is, “What has this experience shown us about what I may need next?”
What TMS is, and what it is not
Transcranial magnetic stimulation, or TMS, is a noninvasive treatment that uses targeted magnetic pulses. These pulses stimulate areas of the brain involved in mood regulation. TMS is FDA-cleared for depression. It does not involve surgery, implanted devices, or anesthesia.
During a session, you remain awake and seated in a comfortable chair. A treatment coil rests against your scalp. You may hear clicking and feel tapping or a brief knocking sensation. Our treatment team stays with you throughout the visit and can talk with you about what you are feeling.
TMS is not electroconvulsive therapy, or ECT. The treatments differ in how they are delivered and what a visit involves. A clinical guide to repetitive TMS describes it as an outpatient treatment delivered through a structured series of visits (Chen et al., 2025).
Why TMS involves a series of visits
TMS is delivered as a course of sessions, not as a one-time procedure. Your schedule and total number of visits depend on the protocol and your individualized treatment plan. Many depression protocols involve weekday appointments over several weeks. Once setup is complete, visits often take well under an hour.
That regularity is an important practical consideration. Before starting, we encourage you to think through transportation, work, school, caregiving, and other responsibilities. A treatment plan should make room for the realities of your life.
Repeated sessions are intentional. TMS appears to affect connected brain networks, rather than acting like an on-and-off switch in one area. A review of TMS mechanisms explains how stimulation may shape activity across these circuits over time (Downar et al., 2024). Research on treatment targets has also linked TMS outcomes with connectivity in mood-related brain networks (Fox et al., 2012).
What happens before your first session
Before recommending TMS, we begin with a psychiatric evaluation. We want to understand your depression history, prior treatment, current medications, medical history, symptoms, and goals. We also review whether TMS is appropriate for you.
That includes important safety questions about seizure history, metal or implanted devices, and other individual factors. If TMS is a reasonable option, early appointments include mapping and calibration. This helps identify the treatment location and settings that are tailored to you.
It is normal to have questions about sensation, time commitment, side effects, or keeping up with ordinary responsibilities during care. We want those questions on the table. Your care should not feel like something that is simply happening to you. It should be a process you understand and participate in.
Some people notice scalp discomfort or headache during or after treatment, especially early in a course. We discuss what to report and ways to make sessions more comfortable.
Your care plan should reflect your whole life
TMS may be one part of depression care. It does not replace every other support in your life. Depending on your needs, a plan may also include psychiatric medication management, psychotherapy, sleep support, routine changes, or coordination with other clinicians. We consider your response over time. We do not assume every person will have the same path.
Depression planning can be especially complex when health concerns, thinking changes, or social stressors are also present. A review of TMS in later-life depression highlights the value of considering those factors in care planning (Cappon et al., 2022). The larger point applies at every age. Good care is personal.
We also offer services that may be relevant to separate conversations about your mental health needs. You can explore our psychiatric services, learn about SPRAVATO® treatment for depression, or read about ketamine therapy. Ketamine for psychiatric uses is off-label. The right discussion begins with your diagnosis, history, safety considerations, and goals, not with a predetermined treatment choice.
When to ask about TMS
You may want to ask about TMS if medication has not provided enough relief. It may also be worth discussing if side effects have limited medication options, or if depression continues to disrupt work, relationships, rest, or self-care. Research on people with marked treatment-resistant depression shows that treatment histories can be extensive and varied, which is why an individualized review matters (Conway et al., 2024).
Bring a list of prior medications, therapy experiences, questions, and goals to an evaluation. That can help us better understand what you have tried and what matters most to you now.
At HavenNexus Advanced Psychiatry & TMS, we can help you consider TMS in the context of your whole history and decide whether further evaluation makes sense. You can begin with our TMS self-assessment or request an appointment when you are ready to talk.
If you are in immediate danger, have thoughts of harming yourself, or cannot stay safe, call or text 988 to reach the 988 Suicide and Crisis Lifeline, call 911, or go to the nearest emergency department. You deserve immediate support in a crisis.
Works Cited
1. McIntyre RS, et al. Treatment-resistant depression: definition, prevalence, detection, management, and investigational interventions. https://pubmed.ncbi.nlm.nih.gov/37713549/
2. Chen L, et al. Treating Depression With Repetitive Transcranial Magnetic Stimulation: A Clinician's Guide. https://pubmed.ncbi.nlm.nih.gov/40302403/
3. Touloumis C. The burden and the challenge of treatment-resistant depression. https://pubmed.ncbi.nlm.nih.gov/34990376/
4. Downar J, et al. Mechanisms of Action of TMS in the Treatment of Depression. https://pubmed.ncbi.nlm.nih.gov/38844713/
5. Fox MD, et al. Efficacy of transcranial magnetic stimulation targets for depression is related to intrinsic functional connectivity with the subgenual cingulate. https://pubmed.ncbi.nlm.nih.gov/22658708/
6. Cappon D, et al. Transcranial magnetic stimulation (TMS) for geriatric depression. https://pubmed.ncbi.nlm.nih.gov/34839043/
7. Conway CR, et al. Clinical characteristics and treatment exposure of patients with marked treatment-resistant unipolar major depressive disorder: A RECOVER trial report. https://pubmed.ncbi.nlm.nih.gov/38574853/
Disclaimer
This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.