by Cayden Antee, Synergy Strive TMS Treater (Silver Spring)
Oftentimes, transcranial magnetic stimulation (TMS) is discussed as a replacement of antidepressant medication. Simultaneously, though, many TMS patients are encouraged by their providers, therapists, or doctors to stay on medication, even after a successful round of TMS. So which is it? Here are some factors to consider when making this decision.
Most, if not all TMS patients have struggled with antidepressants, meaning they usually had one of the following experiences:
1. Antidepressants did not significantly combat depressive symptoms
and/ or
2. The side effects of antidepressants made them intolerable
Both of these are incredibly (and equally) common.
Among these two, someone with the second presentation –that is, someone who cannot tolerate the side effects of antidepressants– is much more likely to replace medication with TMS. Someone who simply hasn’t seen full improvement from medication may be more incentivized to take a multi-method approach by staying on antidepressants.
It’s important to remember that depression is episodic, meaning it comes in waves. If a patient has experienced more persistent depression and more regular depressive episodes, we recommend continuing medication to mitigate the risk of slipping back into an episode. If someone has recently begun experiencing depression in adulthood, they’d be more likely to stop taking medication after a successful round of TMS.
A similar story is true for the severity of episodes. If depressive episodes have historically shown themselves to be severe (e.g., loss of daily function, suicidality, hospitalization), patients are recommended to remain on medication, simply on account of the heightened consequences of relapse. If episodes are more minor and patient functioning has remained mostly intact, it may be more reliable to discontinue medication.
If extrinsic factors (e.g., employment stress, financial hardship, relationship precarity) are present in a patient’s life, continuing to take antidepressants may buffer against factors that increase the risk of depressive episode relapse. Folks with depression more closely related to intrinsic factors (e.g., self-esteem, anxiety, motivation) may choose to discontinue medication after successful TMS, since their external environments aren’t excessively vulnerating them to depression and their internal environments have been improved by TMS.
Perhaps the largest deciding factor are patients’ treatment goals. For patients who see TMS as a component in their larger mental health support system, continuing antidepressants may just be another step in the perpetual journey of self-help and actualization.
Alternatively, for those who see TMS as a means to the end of feeling “normal”, or those who view mental healthcare as a temporary intervention as opposed to a constant in their lives, discontinuing medication is often the elected decision.
| Patient Remaining on Antidepressants Post-TMS | Patient Discontinuing Antidepressants Post-TMS |
| Alex has been depressed since she was 12, but antidepressants haven’t really helped her– she struggles to keep a job, and her four kids make the budget at home tight. She feels like there’s a long road ahead, but one she’s willing to endure for herself and her kids. | Jamie has been depressed for two years, but antidepressants make her feel like a zombie. Her life is pretty good, and she thinks she should be happy like she used to be. She just wants things to go back to normal, but she can’t tolerate medication. |
If you’re looking into TMS, we’d love to help. Fill out the contact portal on this page or give us a call and we’ll be in touch to discuss whether TMS is right for you! We offer insurance-covered NeuroStar TMS in Columbia, Towson, and Silver Spring, MD.
