medically reviewed by Dr. Lindsay Israel
You’re not alone.
Only 1 in 4 people benefit from antidepressants!
So what are your options?
Well, for years, the only FDA-approved treatments for depression were oral antidepressants.
All that changed in 2008 when TMS (transcranial magnetic stimulation) was approved.
Our Breakdown Includes:
- Comparison chart
- What is TMS?
- What are antidepressant meds?
- Side effects of TMS and Meds
- Effectiveness of TMS and Meds
- Pros & Cons
- Benefits of combining both
Comparison Chart – TMS vs Medications
What is TMS?
TMS utilizes magnetic pulses to treat depression, anxiety, OCD, and other mood disorders.
TMS stands for Transcranial Magnetic Stimulation so it uses magnets, NOT electricity like ECT!
These magnetic pulses gently stimulate a specific area of the brain that stopped working properly in individuals with depression symptoms.
Notice how little brain activity you have when you’re depressed?
If you’re depressed, areas of your brain don’t function the way they should. The communication, using neurotransmitters, is just not active enough.
TMS therapy encourages the brain to stimulate electrochemical signaling, which is how different parts of the brain communicate with each other.
Where does TMS Therapy Stimulate?
The area needing help is called the Dorsolateral Prefrontal Cortex or DLPFC for short.
The DLPFC is a relatively superficial location, which makes it easy for the magnetic pulses to reach.
We’re lucky because your DLPFC is connected to deeper brain structures that are also involved in mood regulation. So, when you treat the DLPFC, you treat that entire circuit, like a domino effect!
With TMS, the brain can “relearn” how to modulate the neurotransmitters involved in electrochemical signaling.
What are Antidepressant Medications?
If you’re reading this, chances are, you’re on or have tried antidepressants.
Oral antidepressants have been the traditional treatment of choice for depression.
There are various classes of antidepressants and each designed to act a certain way.
In general, medications either block or activate different receptors, some are targeted more specifically than others. Simple right?
Meds either raise or lower the levels of neurotransmitters in the brain, giving an effect over time.
Meds don’t discriminate. They also affect other areas of the body. The same receptors found in your brain are also found in other organs too, like the intestinal system or the heart. That’s why medications very often cause side effects (systemic side effects) in the body.
You often find yourself taking 2 or more medications at a time. Why? There are many neurotransmitters involved in depression but the medications only modulate specific ones.
This is why medications alone are not usually enough to completely resolve depression symptoms.
Side effects occur when treatment causes a problem because it does more than treat the target issue.
We’ve all seen the commercials that promote medications. Half meds, half side effects.
Let’s get into Medications vs TMS when it comes to side effects.
Side Effects of Medications
Side effects typically vary by the different classes or family of antidepressant medications.
SSRI’s or Selective Serotonin Reuptake Inhibitors are the current “gold-standard”. These are considered the first-line traditional medication treatment class.
The SSRIs modulate levels of Serotonin in the system.
SSRI Side Effects Include:
- upset stomach
- sleep disturbance
- weight gain
- sexual side effects
This class of medications also carries a black box warning from the FDA for increasing suicidal thoughts in patients under 24 years old.
Examples of SSRIs include Prozac, Zoloft, Paxil which are older SSRIs, and newer ones including Viibryd and Trinetellix.
SNRI’s or Selective Seratonin-Norepinephrine Reuptake Inhibitors (SNRI) target both the serotonin and the norepinephrine receptors.
As norepinephrine is also known as the “adrenaline chemical,” these medications can cause elevations in blood pressure as well as a restless feeling. Also, if taken too late in the day, the SNRIs can cause insomnia, as they are known to be activating.
Examples of SNRIs are: Cymbalta, Effexor and Pristiq, as well as newer ones such as Savella and Fetzima.
Wellbutrin a third medication that is basically in a class of its own is.
This medication modulates both dopamine and norepinephrine and is commonly used in combination with the SSRIs.
Wellbutrin Side Effects Include
- upset stomach
- worsens irritability
In addition, this medication can make it easier to have a seizure in high-risk patients, such as those with a history of seizures or an active eating disorder. Therefore, Wellbutrin is contraindicated in those patients.
One of the earlier class of medications are the Tricyclic antidepressants.
This category is notorious for causing many side effects because this family affects many different receptors.
Tricyclic Side Effects Include:
- dry mouth
- dry eyes
- upset stomach
- heart arrhythmia
The most serious of adverse reactions is that it can cause heart arrhythmia and tricyclics are potentially lethal in overdose.
Side Effects of TMS
TMS very targeted treatment so it does not cause side effects.
The pulses can cause scalp tenderness when the pulses are emitting, but rarely causes a lasting headache. TMS has a less than 0.1% risk of seizure.
Some patients can feel a little tired after the first few treatments, as it is like a “work-out” for the brain.
How much did this treatment affect and how long should the results last?
Effectiveness of Medication
Oral antidepressants offer about a 30% remission rate for depression and a 47% response rate (at least a 50% improvement in depression symptoms).
This was evident by the landmark Star*D trial that demonstrated a decrease in response rates with each new medication trial for individual patients. This was a “real world” view of antidepressants, as the majority of patients do not remain on the same medication as they first started.
Effectiveness of TMS
TMS has demonstrated a 62% remission rate from depression and an 83% response rate in various studies. These rates can hold for at least 12 months after one treatment course.
Pros and Cons
How much do the benefits outweigh the disadvantages when it comes to TMS and depression medications?
Pros & Cons of Medications
- covered by almost all insurance plans
- taken every day without requiring a daily office visit
- systemic side effects
- severe withdrawal when stopped
Pros & Cons of TMS
- covered by almost all insurance plans
- daily treatment for 30 consecutive treatments
- no systemic side effects
- no withdrawal when treatment ends
As you can see, both medications and TMS have their own set of pros and cons.
Both medications and TMS are covered by almost all insurance plans, however, currently, insurance companies require some type of attempt to try medication before TMS can be approved and covered.
These restrictions have been slowly lightening up over the last couple of years, as many patients are speaking up and demanding the non-medication option as first-line treatment.
Medications can be taken every day without requiring a daily office visit, as TMS does entail coming in for daily treatment for 30 consecutive treatments.
However, with medications, there does not seem to be an end in sight as far as when is it ok to discontinue the medications. TMS is a definitive treatment course, consisting of 30 consecutive treatments and 6 tapering treatments.
Many patients experience a severe withdrawal when they make an attempt to stop or wean oral antidepressants. There is no withdrawal issue after completing the TMS treatment course.
Benefits of Combining Both
If you suffer from depression, there is usually not anyone factor that caused your depression, and therefore, typically there is not anyone intervention that can pull you out of it.
Some patients do find that they are able to better achieve full remission from depression when they use TMS in combination with an oral antidepressant.
The benefit of combining these to modalities is that TMS can give the patient a better opportunity to only take one medication at minimal doses, rather than multiple medications simultaneously pushed to the maximum dosage.
A compensation option is especially effective for people with a long history of many recurrent depressive episodes. They complete a course of TMS and then continue a single antidepressant as maintenance to prevent more episodes.
The truth is everyone who experiences depression has their own story to tell, their own way that it negatively impacts their lives.
There are some aspects with depression though, that remain relatively consistent, and this is the havoc it wreaks on those suffering from depression and their loved ones.
Maintaining hope that depression can be treated is important to always remember.
Society is taking mental health awareness much more seriously. Now, with the current technological advances in the world of mental health, we have many more tools to reach for and offer to people with this debilitating condition.
Now we can throw stronger and more durable lifelines to pull people out of the darkness and get them feeling like themselves again.
Want more info on TMS?
We, Success TMS, are the 2nd largest provider of TMS in the country.