Can TMS Therapy Be an Effective First-Line Treatment for Depression?

For decades, the standard first-line treatments for depression have typically included antidepressant medications, psychotherapy, or a combination of the two. While these approaches work well for many people, they don’t help everyone. A growing number of patients and providers are now asking an important question: Can Transcranial Magnetic Stimulation (TMS) therapy be considered an effective first-line treatment for depression?

What Is TMS Therapy?

TMS is a non-invasive procedure that uses targeted magnetic pulses to stimulate nerve cells in specific regions of the brain associated with mood regulation, particularly the prefrontal cortex. The goal is to increase activity in areas that may be underactive in people with depression. TMS is FDA-approved for treating major depressive disorder, especially in cases where medications have failed.

The Traditional Approach to Treating Depression

Most people diagnosed with depression begin their treatment journey with medication. Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are often prescribed. If symptoms persist or side effects become problematic, doctors may add or switch to other medications or recommend therapy such as cognitive behavioral therapy (CBT). This trial-and-error process can take months and leave people feeling frustrated.

Why Consider TMS Earlier in the Process?

Traditionally, TMS therapy has been reserved for people with treatment-resistant depression—those who have tried and failed to respond to at least one or more medication. But recent studies are prompting mental health professionals to rethink this approach. Evidence suggests that TMS may be equally or more effective when introduced earlier in treatment, rather than waiting until several medication trials have failed.

According to a 2021 study published in The Journal of Clinical Psychiatry, TMS showed higher remission rates and fewer side effects compared to standard medications in patients who had not yet tried multiple drug therapies. This indicates that patients may benefit more when TMS is used sooner rather than later.

Benefits of Using TMS Early

Fewer Side Effects

One of the biggest drawbacks of antidepressants is their side effects, which can include weight gain, sexual dysfunction, fatigue, insomnia, and emotional numbing. TMS therapy generally does not cause these systemic side effects. The most common side effect of TMS is mild scalp discomfort or headache at the site of stimulation, which usually goes away after the first few sessions.

Avoiding the Medication Roller Coaster

Finding the right antidepressant and dosage often involves a lengthy trial period, sometimes with weeks or months between adjustments. During that time, patients may continue to suffer. TMS bypasses that uncertainty and can provide symptom relief without the biochemical guesswork.

Fast Onset of Relief

Some patients report improvements in their symptoms within a couple of weeks of starting TMS treatment. In comparison, most antidepressants take 4 to 6 weeks to begin working. Early symptom relief can be critical in reducing the risk of worsening depression, including suicidal thoughts.

Long-Term Effects

A 2019 study published in Brain Stimulation found that many patients who responded well to a full course of TMS treatment remained symptom-free six months after their sessions ended. The durability of symptom relief makes TMS an appealing option for those looking for long-term improvement without ongoing medication use.

What About Cost and Accessibility?

One of the main reasons TMS has traditionally been a later option is cost. TMS therapy is more expensive up front than medication. However, insurance companies are increasingly covering TMS therapy, even for patients who haven’t tried numerous medications. The shift in coverage is a direct response to its effectiveness and long-term cost-efficiency compared to prolonged medication use or hospitalization.

Is TMS Right for Everyone as a First-Line Option?

While TMS has shown promise, it’s not ideal for everyone. Patients with certain medical devices, a history of seizures, or specific neurological conditions may not be candidates. In addition, some people prefer the convenience of taking a pill daily over attending 20 to 30 in-office treatment sessions over several weeks.

However, for patients who are hesitant about medication or have struggled with past side effects, TMS could be a reasonable starting point in their treatment journey. It may also be especially appealing to those who are eager to try a non-drug option first.

What Do Providers Say?

Mental health professionals are becoming more open to re-evaluating when TMS should be introduced in treatment plans. Psychiatrists and neurologists who specialize in neuromodulation techniques often advocate for using TMS earlier, especially when patients express concerns about medication side effects, pregnancy risks, or long-term dependency.

In 2022, a consensus statement published by a panel of leading psychiatrists in The American Journal of Psychiatry recommended expanding access to TMS as a first-line treatment option in specific clinical situations, including patients with high risk for medication non-compliance or sensitivity.

The Role of Personalization in Mental Health Care

Every person’s experience with depression is different. Treatment that works for one individual may not work for another. The key is offering choices and creating personalized plans that account for each patient’s unique needs and preferences. As our understanding of mental health evolves, so does the way we approach treatment.

By including TMS as a possible first-line treatment, providers empower patients with more options from the very beginning. Instead of being a last resort, TMS can become an important early intervention tool.

TMS therapy is already changing lives for people with treatment-resistant depression. But recent research and clinical experiences suggest that we may be underestimating its power when reserved for later stages. Offering TMS therapy earlier could shorten suffering, reduce reliance on medications, and help people regain their quality of life faster.

As awareness continues to grow and more insurance providers expand their coverage, TMS has the potential to shift from a backup plan to a mainstream choice for those beginning their journey toward mental wellness.