Antidepressants are usually the first step because they’re easy to start and work well for many people, while TMS is a non-medication, in-office treatment that often helps when one or more antidepressants haven’t worked or have caused side effects you couldn’t live with. Neither is automatically “better” – the right choice depends on your symptoms, your medication history, and how your body responds.
At our practice in Charlotte, Camellia Douglas treats depression using both approaches – sometimes separately, sometimes together. Our philosophy is to “get to the bottom line” through active listening and a personalized plan, fusing interventional treatments with traditional care.
Depression, or Major Depressive Disorder (MDD), is more than a low mood. It can affect your sleep, appetite, concentration, energy, and your ability to feel pleasure in things you used to enjoy – and left untreated, it tends to affect work, relationships, and physical health.
The good news is that depression is treatable, and there is more than one path forward. The main options include:
Medication management – antidepressants and related prescriptions, adjusted over time
TMS therapy – magnetic pulses that stimulate mood-related brain regions
Psychotherapy – talk-based treatment, often paired with the above
Antidepressants are prescription medications designed to relieve depression symptoms by changing how certain chemical messengers work in the brain. They’ve been used for decades and remain the most common first-line treatment for moderate to severe depression.
Your brain uses chemicals called neurotransmitters – serotonin, norepinephrine, and dopamine among them – to pass signals between nerve cells. In depression, these signaling systems are often out of balance.
Most antidepressants increase the availability of one or more of these neurotransmitters, for example by slowing how quickly the brain reabsorbs serotonin. Over several weeks, the brain adapts, and mood, sleep, appetite, energy, and concentration often begin to improve.
The key word is weeks. Most people need four to six weeks at an effective dose before they can judge whether a medication is helping.
SSRIs (Selective Serotonin Reuptake Inhibitors) – the most commonly prescribed class and usually the starting point, since they’re effective with generally fewer side effects than older drugs.
SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) – raise both serotonin and norepinephrine; often used when SSRIs don’t work or when chronic pain or fatigue accompanies depression.
Atypical antidepressants – a mixed group with different mechanisms; some are chosen for their effect on energy, appetite, or sleep, or when other classes cause unwanted side effects.
Choosing among them isn’t guesswork at Mentable. Lab testing can reveal how your body metabolizes certain medications, narrowing the list before you spend months on options that were never a good fit. Learn more about ongoing medication management.
TMS therapy is a non-invasive, non-medication treatment for depression, depression with co-occurring anxiety, and OCD. It uses focused magnetic pulses – similar in strength to an MRI – to stimulate areas of the brain involved in mood regulation.
TMS requires no anesthesia, no sedation, and no downtime. You sit in a chair, awake and alert, and you drive yourself home afterward.
A small electromagnetic coil is positioned against your scalp near the forehead, over the dorsolateral prefrontal cortex – a region involved in mood control and decision-making that is often underactive in people with depression. The coil delivers brief, painless magnetic pulses that pass through the skull and generate a small electrical current in the underlying brain tissue.
Over a series of sessions, this repeated stimulation “wakes up” those underactive cells and strengthens connectivity in the mood-regulating network. Because the magnetic field is targeted rather than circulating through the bloodstream, TMS avoids many of the body-wide side effects people associate with antidepressants.
TMS is typically delivered as a course of daily sessions over 4–6 weeks. Our Charlotte office is open 8:00 a.m. to 5:00 p.m. weekdays, which gives most patients room to schedule before work or on a lunch break.
TMS is generally considered for adults who:
Have been diagnosed with major depressive disorder
Have tried one or more antidepressants without adequate relief (treatment-resistant depression)
Cannot tolerate antidepressant side effects
Want a treatment option that doesn’t involve daily medication
Are dealing with depression accompanied by anxiety, or with OCD
Can commit to the daily treatment schedule for the full course
TMS isn’t right for everyone. People with certain implanted metal devices in or near the head, or with a seizure history, need careful screening. That happens during a thorough psychiatric evaluation, where Camellia Douglas reviews your full history before recommending a path.
TMS Success Rates. Studies show roughly 50–60% of people who haven’t benefited from antidepressants experience a clinically meaningful response with TMS, and about one-third reach full remission – meaning symptoms largely resolve. What makes these numbers notable is who is being studied: people whose depression already didn’t respond to medication.
Improvements also tend to hold. Many patients maintain their gains for months after finishing treatment, and some return for shorter maintenance courses if symptoms creep back.
Antidepressant Success Rates. About one-third of people with moderate to severe depression reach full remission on the first antidepressant they try. But roughly one-third don’t get adequate relief from that first medication, and each additional trial tends to have a lower success rate than the one before.
This is exactly the pattern that led to TMS being developed. When you’ve cycled through two or three medications without real improvement, adding a fourth isn’t always the highest-yield move – though with careful medication management, many people do eventually find an option that works.
Depression: Both TMS and antidepressants can significantly reduce sadness, hopelessness, and feelings of worthlessness.
Anhedonia: The loss of pleasure and interest is one of the most stubborn symptoms and often lingers even when mood improves on medication. TMS shows particular promise here, likely because it directly stimulates reward and motivation circuitry.
Anxiety: Common alongside depression and responsive to both approaches. Certain antidepressants treat anxiety and depression at once, and TMS protocols exist specifically for depression with comorbid anxiety. Read about how anxiety is treated at our practice.
Sleep, energy, and concentration: Often improve with either treatment, though timing differs. Some antidepressants improve sleep within days while mood takes weeks; TMS improvements build gradually across the course.
This is where the two options differ most sharply, and for many patients it’s the deciding factor.
Because TMS is localized and doesn’t enter the bloodstream, side effects are limited and usually mild:
Scalp discomfort, tingling, or a tapping sensation at the treatment site
Mild headache, most common in the first week
Lightheadedness immediately after a session
Facial muscle twitching during stimulation
These typically fade as treatment continues and often respond to an over-the-counter pain reliever or a small adjustment in coil positioning. TMS does not cause weight gain, sexual side effects, emotional numbness, or drowsiness, and has no impact on sleep or appetite.
Antidepressants work systemically, circulating throughout the body. Commonly reported side effects include:
Nausea, diarrhea, constipation, or other digestive upset, especially in the first weeks
Weight gain or other weight changes
Sexual side effects, including reduced libido or difficulty with arousal
Drowsiness or, conversely, insomnia
Dry mouth
Dizziness
A “flat” or emotionally muted feeling
Discontinuation symptoms if stopped abruptly
Many of these ease within a few weeks. Others – particularly weight gain and sexual dysfunction – persist and become the reason people quit medication.
Advantages:
No systemic side effects – nothing enters your bloodstream, avoiding weight gain and sexual dysfunction
No surgery, sedation, anesthesia, or downtime
Highly effective for many people who didn’t respond to medication
Can help with depression, depression with anxiety, and OCD
Benefits often persist after the course ends, with many patients reaching long-term remission
Doesn’t require taking a pill every day
Things to consider:
Requires a daily time commitment, five days a week for 4–6 weeks
You need to travel to the office for each session
Temporary scalp discomfort or headaches are possible
Not appropriate for people with certain implanted metal devices
Typically recommended after medications have been tried
Results build gradually rather than immediately
Advantages:
Simple to start – a prescription and a daily dose that fits most routines
No appointments beyond routine follow-ups
Long track record, widely available, with many options to try
Can be adjusted, combined, or switched as needed
Treats co-occurring anxiety in many cases
Things to consider:
Four to six weeks to know if it’s working
Side effects can be significant and body-wide
May require several trials to find the right fit
Requires daily adherence
Should be tapered rather than stopped suddenly, to avoid discontinuation syndrome
Antidepressants may be the better starting point if you:
Are experiencing your first significant depressive episode or were newly diagnosed
Haven’t tried medication before
Prefer a treatment that fits around a demanding schedule
Have anxiety symptoms a single medication could address alongside depression
Live far from the office and can’t commit to daily visits
TMS may be the stronger choice if you:
Have tried one or more antidepressants without adequate improvement
Stopped medication because of unmanageable side effects
Are dealing with persistent anhedonia despite treatment
Prefer a non-medication approach, or are concerned about long-term medication effects
Have OCD alongside or instead of depression
For many patients, the answer isn’t either/or. TMS can be delivered while you continue a medication that’s partially helping, and combining the two is common – often more effective than either alone.
One of the more important shifts in depression care is moving away from waiting until someone has failed multiple medications before considering other options. Mentable’s approach reflects that, replacing trial-and-error prescribing with real information:
Psychiatric assessments: A comprehensive review of symptoms, history, and treatment goals, grounded in active listening – the details, like what time of day symptoms are worst or how sleep has changed, shape which treatment makes sense.
Lab testing: Thyroid problems, vitamin deficiencies, and hormonal shifts can mimic or worsen depression, and no amount of antidepressant adjustment fixes a problem that isn’t brain chemistry.
Pharmacogenetic testing: Shows whether you metabolize certain medications unusually fast or slow – which explains why a standard dose does nothing for one person and causes heavy side effects in another. Knowing this upfront saves months.
Practical questions to bring to your consultation:
How many antidepressants have I actually tried? Not started – tried, at a full dose, for at least six weeks. If you’ve completed multiple full trials without relief, TMS deserves serious consideration.
What’s my schedule realistically like? TMS requires weekday visits over several weeks; the 8:00 a.m. to 5:00 p.m. hours make this workable for most people.
Which side effects would be dealbreakers? If weight gain or sexual side effects would cause you to quit, say so upfront. That changes the recommendation.
Am I looking for a standalone treatment or an addition? TMS can complement medication rather than replace it.
What else might be contributing? Sleep disorders, thyroid function, ADHD, and substance use all interact with depression. Mentable also offers ADHD testing when attention or cognitive symptoms are part of the picture.
Antidepressants and TMS are both legitimate, evidence-backed treatments for depression – they simply work differently and suit different situations. Medication is often the practical first step, especially for a first episode. TMS is a strong option when antidepressants haven’t produced enough relief or their side effects made treatment unsustainable, and it’s particularly worth discussing if anhedonia or co-occurring anxiety and OCD are part of your picture.
At Mentable in Charlotte, Camellia Douglas evaluates each patient individually – using lab testing and a detailed history to recommend medication management, TMS therapy, psychotherapy, or a combination.
To discuss which approach fits your situation, call (980) 223-4566 or schedule a consultation at our office.
About the Author
Camellia Douglas
MSN, APRN, PMHNP-BC
Ready to Start Your Journey?
August 14, 2026
