TMS vs. Medication: Understanding Your Treatment Options
Compare TMS therapy and psychiatric medications: how they work, benefits, considerations, and how to choose the right approach for you.
Clinically Reviewed: Board-Certified Psychiatrist |Next Review: November 2025
Key Takeaways
- Both TMS and medications are FDA-cleared, evidence-based treatments for depression
- Medications work systemically throughout your body; TMS targets specific brain regions
- Timeline: Medications take 4-8 weeks; TMS requires 4-6 weeks of daily sessions
- Many people benefit from combining both approaches for comprehensive care
- The right choice depends on your treatment history, preferences, and clinical needs
Why Compare TMS and Medication?
If you're struggling with depression, you have multiple evidence-based treatment options. Both Transcranial Magnetic Stimulation (TMS) and antidepressant medications are FDA-cleared treatments with strong research support.
Understanding how they differ—and how they can work together—helps you make informed decisions about your mental health care.
This guide compares both approaches so you can have meaningful conversations with your doctor about what might work best for you.
Side-by-Side Comparison
| Feature | Antidepressant Medications | TMS Therapy |
|---|---|---|
| How it works | Adjusts brain chemistry systemically throughout your body | Magnetic pulses stimulate specific brain regions |
| Administration | Daily pill at home | 20-30 min sessions at clinic, 5 days/week for 4-6 weeks |
| Time to benefit | 4-8 weeks for full effect | 2-6 weeks, cumulative improvement |
| Common side effects | Nausea, sleep changes, sexual effects, weight changes (varies by medication) | Scalp discomfort, mild headache (usually temporary) |
| Systemic effects | Yes - affects entire body | No - targeted to brain only |
| Convenience | High - take at home daily | Moderate - daily clinic visits required |
| Duration of treatment | Often 6-12 months minimum; many continue longer | 4-6 week acute course; some need occasional maintenance |
| Success rate | 50-60% for first medication; higher with multiple trials | 70-75% response rate for treatment-resistant depression |
| FDA status | Multiple medications FDA-approved for depression | FDA-cleared for MDD, OCD, anxious depression |
| Insurance coverage | Widely covered; generic options available | Covered for treatment-resistant depression with prior authorization |
How Antidepressant Medications Work
Antidepressants adjust levels of neurotransmitters (chemical messengers) in your brain, particularly serotonin, norepinephrine, and dopamine. Different classes work in slightly different ways:
- SSRIs (e.g., sertraline, escitalopram): Increase serotonin availability
- SNRIs (e.g., venlafaxine, duloxetine): Increase both serotonin and norepinephrine
- Bupropion: Affects dopamine and norepinephrine; no sexual side effects
- Mirtazapine: Can help with sleep and appetite
Because medications work throughout your entire body, they can cause systemic side effects—both the ones that help (improved mood) and the ones you may not want (nausea, sexual changes, weight shifts).
Learn more: Antidepressants Explained: SSRIs, SNRIs & More
How TMS Therapy Works
TMS uses magnetic pulses to stimulate underactive areas of your brain involved in mood regulation. It's non-invasive—nothing enters your body.
During treatment, a specialized coil placed over your head delivers brief magnetic pulses that:
- Increase activity in brain regions showing reduced function in depression
- Help restore normal neural signaling patterns
- May promote neuroplasticity (brain's ability to form new connections)
- Influence neurotransmitter systems without systemic medication effects
Because TMS targets the brain directly and doesn't circulate through your body, systemic side effects like nausea, weight gain, or sexual dysfunction are not expected.
Learn more: TMS 101: What to Expect
Who Each Approach Helps Most
Medications May Be Best If:
- You prefer the convenience of daily pills at home
- You can't commit to daily clinic visits for 4-6 weeks
- You haven't tried antidepressants yet (first-line treatment)
- You've had good results with medications in the past
- You need long-term maintenance treatment
TMS May Be Best If:
- You've tried multiple medications without adequate relief
- Medication side effects are intolerable
- You prefer a non-medication approach
- You can commit to daily clinic visits for treatment
- You're looking for a targeted brain stimulation approach
Timeline Comparison: Week-by-Week
Medication Timeline
Adjustment period; side effects may be more noticeable than benefits
Some people notice subtle improvements in sleep or energy
Mood improvements become more apparent
Evaluate if medication is working; may adjust dose or try different med
Continue medication to maintain benefits; many stay on long-term
TMS Timeline
Brain mapping, first treatments; mild scalp discomfort common
Side effects lessen; some people notice early improvements
More noticeable mood, energy, and focus improvements
Complete treatment; assess response and plan next steps
Monitor; some benefit from occasional booster sessions
Combining TMS and Medication: The Power of Both
You don't have to choose one or the other. Many people use both approaches together—this is called comprehensive care.
Why combine treatments?
- Different mechanisms working together can produce better outcomes
- TMS may help you respond better to medication or allow lower doses
- Medication can help maintain TMS gains after acute treatment
- Addresses depression from multiple angles simultaneously
Research shows that combining TMS with ongoing medication management can improve response rates and help maintain improvements longer.
Learn more: Comprehensive Mental Health Care
Cost Considerations
Medication Costs
- With insurance: $10-50/month for generic medications; $50-300/month for brand-name
- Without insurance: $20-200/month depending on medication
- Doctor visits: Initial evaluation + follow-ups every 1-3 months
- Lab tests: Some medications require periodic monitoring (cost varies)
TMS Costs
- With insurance: Most plans cover TMS for treatment-resistant depression after prior authorization; copays vary
- Without insurance: Total course cost varies; payment plans often available
- Time investment: Daily 20-30 minute sessions for 4-6 weeks
- No ongoing costs: After completing treatment (unless maintenance needed)
For specific pricing and insurance verification, contact our team at (405) 934-1681 or visit our Insurance page.
Making the Decision: Questions to Ask Your Doctor
When deciding between TMS and medication (or both), consider asking:
- Based on my history, which approach do you recommend and why?
- Have I tried enough medications to qualify for TMS?
- What are realistic expectations for each option in my case?
- Can I combine both approaches? Would that help?
- What are the time commitments for each?
- How will we track if treatment is working?
- What happens if the first approach doesn't work?
- What does my insurance cover, and what will I pay out-of-pocket?
Key Factors in Your Decision
Treatment History
Medications first? If you haven't tried antidepressants yet, they're usually the first-line approach.
Multiple medication failures? TMS is FDA-cleared specifically for treatment-resistant depression.
Lifestyle & Schedule
Busy schedule? Medication may be easier to fit into daily life.
Can commit to clinic visits? TMS requires 4-6 weeks of daily sessions but has no downtime.
Side Effect Tolerance
Sensitive to medications? TMS doesn't cause systemic side effects like nausea, weight changes, or sexual dysfunction.
Medication side effects manageable? Many people tolerate medications well, especially after the first few weeks.
Insurance & Cost
Insurance coverage? Verify what your plan covers for both options.
Out-of-pocket concerns? Compare total costs for each approach including visits, tests, and treatment fees.
What the Research Shows
Both TMS and antidepressant medications have strong evidence supporting their effectiveness:
Medication Evidence
- 50-60% of people respond to their first antidepressant medication
- Response rates improve to 70-80% when trying multiple medications or combinations
- Decades of research with millions of patients treated
- Multiple FDA-approved options with different mechanisms
TMS Evidence
- 70-75% response rate in patients with treatment-resistant depression
- 50-60% remission rate (minimal or no symptoms remaining)
- FDA-cleared since 2013; extensive safety data
- Particularly effective when medications haven't provided adequate relief
Frequently Asked Questions
Can I do TMS while taking medication?
Yes! Many people continue their medications during TMS therapy. In fact, TMS often works well alongside medication management. Your psychiatrist will coordinate both treatments and may adjust your medications based on how you respond to TMS.
Is one better than the other?
Neither is universally 'better'—both are effective, FDA-cleared treatments. The best choice depends on your individual situation: treatment history, medication response, side effect tolerance, lifestyle, and preferences. Some people prefer medication's convenience; others prefer TMS's targeted, non-systemic approach.
What if I've failed multiple medications—will TMS work?
TMS is specifically FDA-cleared for people who haven't responded adequately to antidepressant medications. Clinical studies show TMS can be effective even when multiple medications haven't worked. However, TMS isn't guaranteed—response rates are around 70-75% for treatment-resistant depression.
Can I switch from medication to TMS?
Yes, you can transition from medication to TMS, though it's often done gradually. Your doctor may recommend staying on medication during TMS therapy, then tapering after you've responded to TMS. Never stop medications abruptly without medical guidance.
How do costs compare?
Both can be covered by insurance with prior authorization. Medication costs vary widely ($10-300/month depending on the drug and insurance). TMS is typically covered for treatment-resistant depression. Out-of-pocket costs depend on your specific insurance plan and deductible.
Which works faster?
Timelines are similar. Most antidepressants take 4-8 weeks to show full benefits. TMS requires 4-6 weeks of daily sessions with improvements often appearing around weeks 2-4. Neither is a 'quick fix,' and both require patience and consistency.
Can I try TMS first without trying medications?
Generally, no. Insurance typically requires documentation that you've tried at least one antidepressant before approving TMS. FDA clearance for TMS is specifically for treatment-resistant depression, meaning medication trials are usually expected first.
What if TMS doesn't work—can I still try different medications?
Absolutely. If TMS doesn't provide adequate relief, you can work with your psychiatrist to try different medications or medication combinations. Some people also benefit from combining ongoing TMS maintenance sessions with medication management.
Do most people choose medication or TMS?
Most people try medications first because they're typically more accessible and don't require daily clinic visits. TMS is usually considered when medications haven't worked well, cause intolerable side effects, or when someone prefers a non-medication approach.
How do I know which is right for me?
Discuss with your psychiatrist. Consider: Have you tried medications before? How did they work? Can you commit to daily TMS sessions for 4-6 weeks? What are your preferences? Your doctor will help evaluate which approach—or combination—makes most sense for your situation.
Plain-Language References
- 1. Medication response rates: Rush AJ, et al. (2006). "Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report." American Journal of Psychiatry.
- 2. TMS efficacy: Levkovitz Y, et al. (2015). "Efficacy and safety of deep transcranial magnetic stimulation for major depression." World Psychiatry.
- 3. Treatment-resistant depression: FDA guidance on TMS for patients who have not responded adequately to antidepressant medications.
- 4. Combination therapy: Philip NS, et al. (2016). "Network mechanisms of clinical response to transcranial magnetic stimulation in posttraumatic stress disorder and major depressive disorder." Biological Psychiatry.