TMS vs. Other Treatments for Depression: A Side-by-Side Guide

Antidepressants and talk therapy are the most common treatments for depression, but they aren’t always effective. Sometimes a different therapy or a combination of therapies works better. One such treatment is Transcranial Magnetic Stimulation (TMS), an FDA-cleared, non-invasive neuromodulation treatment for people living with depression and other mood disorders. TMS uses magnetic pulses, similar in strength to an MRI, to activate brain regions that are underactive in depression.[1] 

People may ask: How does TMS compare to other treatments for depression, and which is best for me? In this article, we explore how TMS compares to other treatments, including medication, psychotherapy, esketamine, ECT and neurofeedback to help patients make more informed decisions about their care.

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How TMS Compares to Other Depression Treatments

Depression is a complex brain health condition without a one-size-fits all solution. A treatment plan that works well for one person may prove ineffective or be poorly tolerated by another. We compare TMS to other depression treatments, drawing on recent clinical evidence.

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TMS vs. Antidepressant Medication

Antidepressants are the first line therapy for depression treatment for most people diagnosed with depression. They boost serotonin levels and help restore connections and communication in the brain. [2]

While medications such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can provide relief, for some patients, they may prove ineffective or cause unwanted side effects. Patients can become frustrated and disillusioned when they have to try different antidepressants in an effort to find one that works. Data from the landmark STAR*D trial—the largest prospective study of antidepressant treatment ever conducted—revealed that only 36.8% of patients achieved remission with their initial medication, with remission rates declining further with each subsequent trial.[3]

TMS offers a neurologically targeted alternative treatment option for patients who have not responded to at least two adequate medication trials. TMS uses focused magnetic pulses to directly stimulate the left dorsolateral prefrontal cortex, a region consistently implicated in mood dysregulation, thereby avoiding systemic changes to brain chemistry. TMS does not cause unwanted side effects, such as weight gain, sexual dysfunction, sedation, or the withdrawal effects commonly associated with antidepressants.

A 2024 multicenter randomized controlled trial comparing repetitive TMS (rTMS) with antidepressants found that rTMS resulted in a significantly larger reduction in depressive symptoms than medication.[4] These results were also reflected in higher response (37.5% vs. 14.6%) and remission (27.1% vs. 4.9%) rates.

Salma Health’s Medication Management team can help you determine whether a medication adjustment, TMS, or a combination of both is the most appropriate next step.

TMS vs. Psychotherapy (CBT, DBT)

Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and other evidence-based approaches help address the psychological, behavioral and relational dimensions of depression. For example, these therapies help people build coping strategies, restructure maladaptive thinking patterns, and process underlying contributors to low mood.

TMS, by contrast, works at the neurological level by stimulating circuits that regulate mood and motivation. A 2025 expert consensus review supported by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology confirmed that TMS and psychotherapy are commonly combined in clinical practice and mutually enhance the other’s therapeutic gains.[5] Many patients find that TMS lifts enough of the mental heaviness of depression that they feel more like themselves and are better able to open up and engage during therapy sessions.

TMS vs. Esketamine (SPRAVATO®)

Intranasal esketamine (Spravato) and TMS are both FDA-approved options for treatment-resistant depression (TRD). A 2025 study that directly compared TMS and esketamine (a nasal spray treatment for depression) found that both worked better than simply switching to a new antidepressant and that neither treatment was clearly superior to the other. The authors noted that rTMS may be superior or at least similarly effective, and called for prospective head-to-head trials to confirm these preliminary findings.[6]

In practical terms, TMS and esketamine work quite differently. TMS sessions are non-sedating and do not require a post-treatment monitoring period—most patients can drive themselves home and return to normal activities immediately. In contrast, esketamine is administered in-office and requires approximately two hours of observation due to the risk of dissociative effects. Conventional TMS requires a longer initial treatment course (typically four to six weeks of daily sessions), while esketamine can produce effects within hours. 

The Stanford Accelerated Intelligent Neuromodulation Therapy, or SAINT® TMS, was approved in 2022 for treatment-resistant major depressive disorder (MDD). SAINT delivers a shorter course of treatment of MRI-guided magnetic pulses over five days. For some patients, speed of onset is the deciding factor; for others, the potential side effects or logistics are key determinants. To learn more, visit the Esketamine / Spravato service page.

TMS vs. Electroconvulsive Therapy (ECT)

Electroconvulsive therapy (ECT) has long been considered the most powerful treatment available for patients with severe depression who haven’t responded to other approaches, especially for those who are also experiencing psychosis or are at immediate risk of suicide. The procedure involves triggering a brief, controlled seizure while the patient is under general anesthesia. Typically, it requires several sessions per week over the course of a few weeks. While ECT is effective, it comes with real drawbacks, including short-term memory loss, other cognitive side effects, the need for anesthesia and close medical supervision, and a level of stigma that leads many patients to avoid it.

A 2025 review comparing ECT and TMS found that ECT still has the edge for the most severe cases, but also confirmed that TMS is significantly easier to tolerate, with fewer side effects and no need for anesthesia.[7] Recent technological advancements such as SAINT have made TMS a more popular treatment option. The intensive, five-day program delivers ten sessions per day, with each session precisely guided by the patient’s own brain imaging data gathered from an MRI. In a rigorous clinical trial, it produced an 85.7% response rate and a 78.6% remission rate in patients with treatment-resistant depression, with 60% of those patients still in remission a month later.[8]

For patients who are not candidates for ECT, have declined it, or are seeking a less invasive option with a strong evidence base, SAINT TMS at Salma Health represents a compelling and rapidly acting alternative.

TMS vs. Neurofeedback

Neurofeedback is a technique that teaches patients to recognize and adjust their own brainwave patterns using real-time data to essentially train the brain the way you might train a muscle. Many patients are drawn to its non-invasive, self-directed nature. However, treatment protocols vary widely between providers, the clinical trial evidence is limited, and neurofeedback has not been cleared by the FDA for the treatment of depression.

TMS has FDA clearance for major depressive disorder, has been tested in thousands of patients across multiple large, independent clinical trials, and is recognized in expert treatment guidelines. For patients looking for a non-medication option with a strong, well-established track record, TMS is currently the more proven choice.

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What Makes TMS Therapy Unique Compared to Other Depression Treatments?

Here is what distinguishes TMS from other available options:

• FDA-cleared for major depressive disorder, backed by substantial randomized controlled trials and real-world evidence.
• Non-invasive and non-sedating—no anesthesia, no needles, no downtime.
• No systemic side effects: no weight gain, sexual dysfunction, sedation, or withdrawal symptoms.
• Real-world response rates up to 83%, with remission rates exceeding 50% in consensus data.
• Accelerated protocols (e.g., SAINT) can complete a full treatment course in five days, with 78.6% remission reported in controlled trials.
• Can be safely combined with antidepressants, psychotherapy and other treatments.
• Covered by most major insurance plans for qualifying patients.

Learn more about TMS treatment by visiting Salma Health's TMS Therapy page.

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Can TMS Be Combined with Other Depression Treatments?

In practice, combining treatments is common. Most patients who undergo TMS are already taking antidepressants and engaged in psychotherapy, which is both safe and often associated with better outcomes. The 2025 consensus review confirmed that concurrent use of antidepressants with TMS is routine, and that, in particular, co-administration of SSRIs with TMS has been associated with improved outcomes.⁵

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TMS and Antidepressants

A 2024 randomized controlled trial demonstrated the superiority of rTMS over antidepressant switching. Enrolled patients were on concurrent medications, which reinforces that TMS integrates effectively into an existing medication regimen rather than replacing it.⁴ Some patients find that TMS amplifies the response to a medication that previously provided only partial relief. To learn more, read our article on combining TMS with antidepressants.

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TMS and Psychotherapy

Many patients keep attending weekly therapy sessions while they're going through TMS treatment. The two work well together because they target depression from different angles: TMS works on the brain directly, while therapy addresses thoughts, emotions, and behavior.

Combination treatment often works best for individuals with moderate-to-severe depression, those with mixed results from previous treatments, individuals who also struggle with anxiety, or anyone seeking to address both the brain-based and emotional aspects of their depression simultaneously. Your provider can help you figure out which combination makes the most sense for your specific situation.

Is TMS Right for You?

If you're living with depression and wondering if TMS could be a better fit than your current treatment or a complementary addition, having a conversation with a qualified provider who understands your history can help. At Salma Health, we offer free consultations to help you understand your options, without pressure and without assuming what the right treatment path looks like for you. Contact us to schedule a consultation and let us help you find the approach that works for your life. 

^{Cited Sources:} 

^{[1] Salma Health. Transcranial Magnetic Stimulation (TMS) Therapy. https://www.salmahealth.com/treatments/transcranial-magnetic-stimulation-tms}

^{[2] Page CE, Epperson N, Novick AM, et al. Beyond the serotonin deficit hypothesis: communicating a neuroplasticity framework for major depressive order. Molecular Psychiatry 2024;29:3802–3813. https://doi.org/10.1038/s41380-024-02625-2}

^{[3] Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905–17. doi:10.1176/ajp.2006.163.11.1905}

^{[4] Dalhuisen I, van Oostrom I, Spijker J, Wijnen B, van Exel E, van Mierlo H, et al. rTMS as a next step in antidepressant nonresponders: a randomized comparison with current antidepressant treatment approaches. Am J Psychiatry. 2024;181(9):806–14. doi:10.1176/appi.ajp.20230556}

^{[5] Trapp NT, Purgianto A, Taylor JJ, Singh MK, Oberman LM, Mickey BJ, et al. Consensus review and considerations on TMS to treat depression: a comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology. Clin Neurophysiol. 2025;170:206–33. doi:10.1016/j.clinph.2024.12.015}

^{[6] Kaster TS, Dai Y, Vila-Rodriguez F, Downar J, Daskalakis ZJ, Blumberger DM, et al. Efficacy of intranasal esketamine versus rTMS for treatment-resistant depression: analysis of individual participant data from two clinical trials. EClinicalMedicine. 2025;79:103609. doi:10.1016/j.eclinm.2025.103609}

^{[7] Thurstan Z, Hyland D. A comparison of the efficacy of electroconvulsive therapy and transcranial magnetic stimulation in the treatment of depressive disorder – is one better than the other? BJPsych Open. 2025. doi:10.1192/bjo.2025.10140}

^{[8] Cole EJ, Phillips AL, Bentzley BS, Stimpson KH, Nejad R, Barmak F, et al. Stanford Neuromodulation Therapy (SNT): a double-blind randomized controlled trial. Am J Psychiatry. 2022;179(2):132–41. doi:10.1176/appi.ajp.2021.20101429}