What Is the Next Step If TMS Doesn’t Work?

If TMS hasn’t led to meaningful improvement by session 20, I carefully reassess coil position, motor threshold, and dosing, and, if tolerated, increase settings to a clearly therapeutic level. At this point, I also encourage adding psychotherapy and considering starting or adjusting medications that haven’t been tried before.

Completing the Course

There is no medical harm in completing all 36 TMS sessions to obtain a definitive answer, though practical considerations like scheduling and logistics may come into play. While a small minority of patients respond later in the course, most do not experience improvement if there has been zero change by session 20.

Reevaluating Your Diagnosis and Contributors

I revisit the diagnosis and consider contributing factors such as trauma, personality traits, and active substance use. I also coordinate closely with your primary psychiatrist, who can provide insight into your long-term patterns and past treatment responses.

Next-Line Treatment Options for Resistant Depression

If TMS hasn’t led to meaningful improvement, it’s important to consider additional steps to address treatment-resistant depression and ensure a comprehensive approach.

• Medication strategies you may not have tried, including older classes such as MAOIs.
• Evidence-based psychotherapy, including approaches tailored to trauma or personality patterns.
• ECT for severe, treatment-resistant depression. ECT remains the most effective acute treatment we have, with the highest remission rates across modalities.

Author: Dr. Hong Yin 

Hong Yin, MD, has been a practicing medical professional in the Milwaukee community since 2012. She understands that your health and wellness concerns extend beyond routine medical care. She’s a highly trained, board-certified psychiatrist who provides an array of comprehensive services and procedures to help people overcome mental health problems.