TMS vs Antidepressants

TMS vs Antidepressants

Kimberly Mercille • January 22, 2025

In this article, we’ll explore how TMS and antidepressants work, compare their effectiveness, safety, and costs, and help you determine which treatment might be right for you. Whether you’re considering TMS, antidepressants, or a combination of both, understanding your options can empower you to make an informed decision about your mental health journey.

What Is TMS?

Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy that uses magnetic fields to stimulate nerve cells in the brain. The US Food and Drug Administration (FDA) approved TMS in 2008 for major depressive disorder (MDD) and later for conditions like obsessive-compulsive disorder (OCD), migraines, and smoking cessation. 

During a TMS session, a coil device delivers magnetic pulses to specific areas of the brain associated with cognition and emotional control. The treatment is painless, requires no anesthesia, and is performed in an outpatient setting. Most patients undergo 20–30 sessions over four to six weeks.

What Are Antidepressants?

Selective Serotonin Reuptake Inhibitors (SSRIs) are a class of antidepressants designed to increase serotonin levels, a neurotransmitter associated with positive mood. Common SSRIs include Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram). Other classes of antidepressants include:

  • SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): Examples include Cymbalta (duloxetine) and Effexor (venlafaxine).
  • MAOIs (Monoamine Oxidase Inhibitors): These older antidepressants, such as Nardil (phenelzine), are less commonly used due to dietary restrictions and potential side effects.

SSRIs, FDA-approved since the 1980s, remain a first-line treatment for depression and are also used for OCD, anxiety, post-traumatic stress disorder (PTSD), and eating disorders. Depending on the type of antidepressant prescribed and the patient’s condition, doses typically range from one to three tablets per day.

Mechanisms of TMS vs. Antidepressants


How TMS Works:

TMS works by using magnetic pulses to generate electrical currents, which activate regions of the brain that are underactive in depression and other mental health disorders. This activation causes the release of key neurotransmitters involved in mood regulation, including glutamate, dopamine, and serotonin. 

Animal research shows TMS affects the genetic expression  of neurotransmitter receptors–proteins that respond to these chemical messengers–potentially explaining long-term changes in mood and well-being. 

TMS also increases measures of   neuroplasticity, which is the capacity of the brain to reorganize and form new neural connections. This could help reset dysfunctional brain circuits and increase someone’s ability to adopt more positive thought and behavior patterns. 


How SSRIs Work:

SSRIs block the reabsorption (reuptake)   of serotonin into neurons. By inhibiting the serotonin transporter (SERT), they increase the availability of serotonin in the space between nerve cells, enhancing its signaling and mood-enhancing effects. 

SNRIs function similarly but also block norepinephrine reuptake. Since norepinephrine regulates energy and attention, SNRIs are particularly beneficial for individuals with depression accompanied by fatigue or difficulty concentrating.

Like TMS, antidepressants may also increase neuroplasticity by boosting brain-derived neurotrophic factor (BDNF), a protein that supports the growth and protection of nerve cells.


Efficacy of TMS vs. Antidepressants


TMS Efficacy:

Research shows TMS is highly effective, particularly for individuals with treatment-resistant depression (TRD) who have not responded to conventional medications. Studies indicate that approximately 50–60% of patients with TRD experience significant symptom improvement with TMS.

In a study of 1,753 patients with depression, over 72% showed substantial symptom improvement following TMS, and more than 58% achieved remission. Most TMS patients notice clinical improvements within two to four weeks of starting treatment.


Antidepressant Efficacy:

SSRIs and other antidepressants are effective for many, but not all. It’s estimated that between 10-30% of people with depression show a very small or no clinical response  despite trying at least two different antidepressant types. Pooled data from eight double-blind studies found remission rates of 45% and 35% for SNRIs and SSRIs, respectively.

Mood improvements tend to appear after the first two weeks of using antidepressants, although it can take up to six weeks for any noticeable improvements. 


Safety of TMS vs. Antidepressants


TMS Side Effects:

TMS is generally well-tolerated, with minimal side effects, such as:

  • Temporary scalp discomfort or headaches during treatment.
  • Lightheadedness after sessions.

Serious side effects are rare but may include seizures, hearing loss, or mania. TMS is not recommended for individuals with a history of epilepsy or brain damage.


Antidepressant Side Effects:

Antidepressants are more likely to cause side effects, including:

  • Nausea.
  • Increased appetite and weight gain.
  • Sexual dysfunction.
  • Insomnia.
  • Emotional blunting or feeling "numb."

Suddenly stopping antidepressants can lead to withdrawal symptoms, which may intensify the drug’s side effects. Long-term risks include cardiovascular disease, type 2 diabetes (likely linked to weight gain), and reduced bone density.


Costs of TMS vs. Antidepressants


Cost of TMS:

TMS sessions cost approximately $200–$400 each, with a full course of treatment (30–40 sessions) being expensive. However, most insurance plans cover TMS as an FDA-approved treatment. Patients may still need to pay co-pays and other fees based on their provider and insurance plan.


Cost of Antidepressants:

The cost of antidepressants varies depending on the medication and insurance coverage. Without insurance, generic SSRIs may cost $20–$50 per month, while brand-name options can exceed $200 per month. Insurance typically lowers these costs, with out-of-pocket expenses depending on the provider.


TMS or Antidepressants: Which Is Right for Me?

Deciding between TMS and antidepressants depends on your medical history and personal preferences.

TMS may be right for you if:

  • You’ve tried multiple antidepressants without significant improvement.
  • You experience severe medication side effects.
  • You prefer a non-invasive, drug-free treatment.
  • You do not have a history of seizures or brain damage.

Antidepressants may be right for you if:

  • You’re experiencing mild to moderate depression and have not tried medication yet.
  • You prefer a familiar, widely available treatment.

For some individuals, combining TMS and antidepressants provides the best results. A mental health professional can help determine the most appropriate approach.


Exploring TMS at The Albany Clinic

If you’re based in Illinois and struggling with depression, TMS treatment at our Carbondale clinic could be the solution you need. Our team of experts provides personalized, evidence-based care to help you on your recovery journey. Benefits of our clinic include:

  • Compassionate, patient-centered care.
  • State-of-the-art TMS technology.
  • Assistance with insurance navigation.
  • Flexible scheduling options.


Take the First Step

Want to learn more? Schedule a free consultation with our team today. We’re here to answer your questions and guide you toward a brighter future.

Book Your Free Initial Consultation

In-Clinic vs. At-Home Ketamine Therapy: What’s Best for Your Mental Health?

By Kimberly Mercille • July 9, 2025
As ketamine therapy becomes increasingly popular for treating mental health conditions like depression and PTSD, more people are exploring their options. At-home ketamine therapy gained traction during the pandemic for its convenience, but without medical supervision, this approach may come with elevated risks. In this article, we’ll explore some of the key differences and pros and cons of in-clinic versus at-home ketamine therapy. What Is In-Clinic Ketamine Therapy? IV Ketamine Treatment In-clinic ketamine therapy involves receiving treatment at a licensed medical facility, such as The Albany Clinic , where professionals monitor and administer the medication under strict protocols. This ensures your safety, especially during your initial sessions. At The Albany Clinic, we specialize in intravenous (IV) ketamine infusion therapy , which has been most well-researched when it comes to treating mental health disorders. IV ketamine bypasses the digestive system, delivering the medication directly into the bloodstream. IV ketamine can help relieve symptoms of various mental health disorders, including depression , anxiety , post-traumatic stress disorder (PTSD) , and more. During an infusion at our clinic, you’ll rest in a calm, controlled environment while ketamine is delivered into a vein through a catheter. Our trained staff will closely monitor your vital signs and mental state throughout the session, adjusting the dose of ketamine if needed. We’ll observe you after treatment to ensure any side effects are managed promptly and effectively. Spravato We also offer Spravato (esketamine) at our clinic, a nasal spray based on ketamine. Unlike other forms of ketamine treatment, Spravato is approved by the FDA and is specifically for adults with treatment-resistant depression or major depressive disorder with suicidal thoughts . Spravato is only approved for in-clinic use under professional supervision and cannot be administered at home, making clinical oversight a legal and medical necessity for this treatment option. During a Spravato session, you’ll self-administer the medication under the supervision of our medical staff. We’ll then closely monitor you for a couple of hours to ensure you’re safe and all side effects have subsided before leaving. What Is At-Home Ketamine Therapy? At-home ketamine therapy allows patients to self-administer the ketamine, typically in the form of lozenges or nasal sprays, delivered via mail. While this option offers flexibility, it usually involves minimal supervision , often limited to virtual check-ins with healthcare providers. Some at-home providers offer optional video support during sessions, but this is not always the case. Patients are largely responsible for monitoring their own physical and emotional reactions, without the benefit of immediate medical intervention if adverse effects occur. At-home treatment often includes supplementary materials , such as guided meditations or journaling tools. However, the lack of real-time clinical oversight makes this option less ideal for those with complex or severe mental health needs. Safety Considerations: In-Clinic vs. At-Home While ketamine therapy is considered safe for most patients, it does come with potential physical and psychological side effects , including: Physical Risks: Elevated blood pressure or heart rate Nausea or vomiting Sedation or dizziness Impaired coordination Rare allergic reactions Psychological Risks: Hallucinations or dissociation Temporary confusion or anxiety Emotional vulnerability during treatment Risk of misuse or dependency The FDA has issued warnings about at-home ketamine use due to its potential for abuse and lack of medical supervision . Without proper monitoring, the risk of addiction and long-term complications, such as bladder damage and cognitive decline, may increase. Key Differences Between In-Clinic and At-Home Ketamine Therapy

A Guide to IV Ketamine

By Matt Rodriguez • July 8, 2025
Intravenous (IV) ketamine has emerged as a promising option for individuals struggling with treatment-resistant depression and other hard-to-treat mental health conditions. Ketamine was originally developed as an anesthetic, but is now being used in controlled medical settings to deliver rapid relief when traditional therapies fall short. This guide explores the history, science, benefits, and practical considerations of IV ketamine therapy and what you can expect from treatment at The Albany Clinic.

Stellate Ganglion Block (SGB) for Depression

By Kimberly Mercille • May 27, 2025
Stellate Ganglion Block (SGB) is an emerging mental health treatment that targets key mechanisms linked to depression. In this article, we’ll discuss the science behind SGB and its potential benefits. If you or someone you know is struggling with depression, this information can help you make an informed decision about whether SGB might be the right option. What is a Stellate Ganglion Block (SGB)? What is the Stellate Ganglion? The stellate ganglion is a cluster of sympathetic nerves located on each side of the neck near the first rib. These nerves are part of the autonomic nervous system, which controls automatic body functions like heart rate, blood pressure, and digestion. The term "stellate" means "star-shaped" because the ganglion often looks like a star under a microscope. It helps regulate the body's stress response by controlling norepinephrine, a chemical that triggers the fight-or-flight reaction. When this system becomes overactive, it can cause various physical and psychological problems, including depression. Stellate ganglion block (SGB) therapy may help by reducing the activity of the stellate ganglion, calming the fight-or-flight response, and lessening the damaging effects of prolonged nervous system stress. How Does Stellate Ganglion Block Work? Stellate Ganglion block (SGB) is when a local anesthetic is injected near the stellate ganglion. These drugs inhibit transmission between nerve cells, dampening activity in the ganglion. They typically include lidocaine, bupivacaine, or mepivacaine, which are sometimes combined with a steroid medication. Patients may also receive another medication to relax them before treatment. SGB is typically performed using ultrasound guidance . The injection process lasts no more than 10 minutes, but patients will motinoted for another 30-45 minutes after treatment to ensure their safety. How Does Stellate Ganglion Block Work for Depression? Chronic stress is a major contributor to depression and is often linked to an overactive sympathetic nervous system. People with depression commonly show high levels of cortisol, a hormone that plays a key role in the body's stress response, in their blood stream. Cortisol is helpful in small doses, but when chronically elevated, it can disrupt neural circuits in the brain. Excessive cortisol can lead to: Neurotoxicity - Cortisol can be toxic to nerve cells, especially in the hippocampus, which is crucial for memory and emotional regulation. Overinflammation - Cortisol increases the activity of the body’s natural defense system, resulting in the system causing damage to nerve cells. Impaired synaptic plasticity - Cortisol inhibits the capacity for the brain to “re-wire” itself. This makes it harder for people to adapt to stressful situations and learn new patterns of behaviour. Disrupted sleep - High cortisol can prevent people from sleeping well. During sleep, restorative biological processes occur in the brain, and excess cortisol can prevent these from happening. SGB decreases sympathetic nervous system activity, which can reduce cortisol levels. This can help restore function in brain areas and pathways associated with positive mood, emotional regulation, and stress resilience. Evidence Supporting SGB for Depression To date, there’s very limited evidence supporting the use of SGB for depression. One pilot study found that SGP significantly reduced depression symptoms in people with treatment-resistant depression (TRD) and was well-tolerated. However, there was no significant difference to the placebo group and the sample size was very small. Nonetheless, multiple lines of research show that SGB can alleviate symptoms of post-traumatic stress disorder (PTSD), which shares similarities with depression. In a trial of SGB for PTSD , participants reported significantly lower scores of depression following treatment. Who May Benefit from SGB for Depression? SGB is primarily utilized for treating PTSD, so individuals with PTSD who also experience depression may find SGB beneficial. Additionally, SGB has shown potential in alleviating anxiety symptoms, suggesting it may be advantageous for those dealing with both depression and anxiety. Because SGB isn’t approved by the FDA, it is typically only used when standard treatments like antidepressants and psychotherapy haven’t worked. SGB is an “off-label” treatment, much like ketamine therapy or brain stimulation therapies. Importantly, SGB may not be suitable for everyone because of medical reasons. Contraindications include: Recent myocardial infarction Coagulopathy or anticoagulant therapy Glaucoma Pre-existing contralateral phrenic nerve palsy Severe emphysema Cardiac conduction block Potential Risks and Side Effects of SGB Common Side Effects Most side effects of SGB are temporary and resolve as the anesthetic wears off. These may include: Hoarseness or Voice Changes: The proximity of the stellate ganglion to nerves controlling the voice box can lead to temporary hoarseness. Drooping Eyelid (Ptosis): Temporary drooping of the eyelid on the side of the injection may occur. Red or Bloodshot Eyes: Some individuals may notice redness in the eyes following the procedure. Watery Eyes and Nasal Congestion: Increased tearing and nasal stuffiness are possible but typically short-lived. Sensation of a Lump in the Throat and Difficulty Swallowing: Some individuals may experience a sensation of a lump in the throat and have difficulty swallowing after the procedure. Warmth or Tingling in the Arm or Hand: A warm or tingling sensation in the affected limb may be experienced temporarily. Although uncommon, some individuals may experience more serious complications, such as nerve damage, seizures, and allergic reactions. Given the potential risks, patients interested in SGB at the Albany Clinic will have an in-depth consultation with one of our qualified healthcare professionals before undergoing treatment. They can assess your medical history, current health status, and the potential benefits and risks of the procedure in your specific case. SGB for Depression in Illinois If you're in the Carbondale area and interested in the potential benefits of SGB for depression, the Albany Clinic is here to help. We specialize in innovative mental health treatments, including SGB, which has been shown to provide rapid relief from mental health symptoms, with effects lasting several weeks. Our experienced team offers personalized support, guiding you through every step—from determining if SGB is the right option for you to exploring alternative treatments and financial considerations. Contact us today to learn more about how we can support your mental health journey.