By Erika Krull, MSEd, LMHP
Searching for the right depression treatment can be frustrating. It's not always a matter of taking a pill and seeing your symptoms go away—everyone's experience with antidepressants is a little different.
The only way to know for certain is to go through a period of trial and error. While this can feel discouraging at times, remember there is hope. Even if medication doesn't prove to be the right treatment for you, transcranial magnetic stimulation (TMS) therapy, a non-medication treatment, may provide a solution. So, how do antidepressants work, and how do they differ from TMS? Here's an overview of the two treatment types and how they compare.
Antidepressants relieve symptoms by working with neurotransmitters, certain chemicals in the brain that affect emotions. These chemicals, which include serotonin, norepinephrine, and dopamine, each send messages through the nervous system. Scientists have designed many different antidepressants to work with each neurotransmitter.
Experts think that with optimal levels of neurotransmitters, your mood and emotions are more positive. With depression, neurotransmitters are underactive and don't allow nerves to signal each other correctly. Scientists believe that antidepressants work by blocking the removal of some of these "chemical messengers" which then increase their activity and restore normal signaling between nerves. These kinds of antidepressants are called reuptake inhibitors, and the most common type is a selective serotonin reuptake inhibitor, also known as an SSRI.
Many people will start feeling better after taking medication for several weeks. Antidepressants can come with side effects, though, and some people may only experience partial relief from them. Your overall health, your specific symptoms, and the medication's side effects can all affect how you respond to a particular antidepressant. People often try more than one antidepressant before they find one that works well, and one in three people ultimately don't find relief from antidepressant medication.
TMS therapy can be an effective treatment option when medications haven't helped. Instead of working through the bloodstream, TMS therapy targets specific areas of your brain directly. Magnetic pulses stimulate the parts of the brain that regulate emotion. This stimulation corrects the way the nerve cells in that area of the brain work, improving your depression symptoms.
TMS therapy takes four to six weeks, with up to five sessions per week. Each session is approximately 20 minutes long, and many people feel comfortable throughout the treatment. Some minor discomforts, like a headache, can happen, but they don't usually last long. Approximately 60% of people who try TMS achieve some level of success with it. With any successful depression treatment, there's always a chance of having another episode of depression months or years later. TMS therapy is typically just as effective the second time as it was the first time.
There are many differences between these two treatments, but one of the primary distinctions lies in how each travel through your body to affect your brain activity. Antidepressants work by flowing through your bloodstream on the way to the brain. This journey through your bloodstream means they can affect other systems in your body. Depending on the medication and your unique physiology, there is a chance of side effects, such as nausea, weight gain, decreased libido, or others. Your doctor can offer more details and discuss how a medication may specifically affect you.
Traveling through your bloodstream also means that medications have to move through the blood-brain barrier before they can have an effect. The blood-brain barrier is what protects your brain from harmful substances in your blood. Unfortunately, it can also affect how well a medication works. Dangerous chemicals are kept out, but medication can sometimes have trouble getting through.
TMS therapy avoids this by targeting a specific area of the brain with gentle magnetic pulses that work to re-activate the parts of the brain responsible for depression. Rather than changing the signaling between nerves, TMS directly restores brain activity back to normal functioning. The treatment process is highly focused and doesn't require a chemical that has to enter the bloodstream. Because of this difference, TMS therapy can sometimes help if antidepressants aren't working or are causing side-effects that are difficult to tolerate.
So, what do you do if antidepressants aren't working for you? First, tell your doctor about your symptoms and how you feel. Stopping or modifying a medication routine on your own can be dangerous, so schedule an appointment with your doctor before considering any changes to your medication. If a medication change does not end up helping, though, it may be time to consider an alternative therapy like TMS. Medication and TMS therapy are both effective treatments for depression. Searching for the right one can be a process, but don't give up. You have the right to keep looking until you find the treatment option that works for you.
If Covid-19 and social isolation are heightening your symptoms of depression, Greenbrook TMS therapy may be able to help. At Greenbrook, we specialize in TMS therapy — an FDA-cleared, non-invasive treatment for treatment-resistant depression and OCD without harmful side effects. See if TMS therapy is right for you by clicking here to take a brief assessment: