TMS for Treatment-Resistant Depression: What to Expect and Who It Helps

If you’ve been living with depression for a long time, you may know the exhausting cycle of trying one medication after another, hoping each new option will finally help. Maybe a treatment worked briefly, helped only slightly, or caused side effects that were too difficult to manage. It’s common to feel frustrated or discouraged, but this does not reflect a lack of effort or strength. Many people simply need a different kind of support.

At Neuromed Clinic, we see this every day. People arrive feeling stuck or disheartened, only to discover that the problem isn’t them, it’s the approach, and this is where Transcranial Magnetic Stimulation (TMS) offers a safe, targeted, and effective next step. This article explains what treatment-resistant depression truly means, why TMS works when medication doesn't, and what you can expect from the treatment journey at Neuromed.

Understanding “Treatment-Resistant” Depression

The phrase “treatment-resistant depression” (TRD) can sound worrying, but it simply means that a person has tried at least two adequate trials of antidepressant medication without significant improvement. Adequate trials include taking the right dose for the right length of time, as guided by a clinician. TRD does not mean depression is untreatable. It means the brain needs targeted help that medication alone has not been able to provide.

There are many reasons someone may fall into this category. You may have found that medication eased symptoms slightly but never enough to feel well. You may have experienced benefits that faded over time. Perhaps the side effects became too burdensome. Or the improvements were inconsistent and you felt better one month, and flattened the next. Some people even feel emotionally “numb” or detached on medication, which can be as distressing as the depression itself.

Other factors such as anxiety, ADHD, trauma, chronic stress, or disrupted sleep can also influence how depression shows up and how it responds to treatment. TMS does not erase these experiences, but by activating under-functioning brain circuits, it often makes it easier to think clearly, regulate emotions, and regain motivation.

Why TMS Works When Medication Doesn’t

To understand why TMS can succeed where medication has struggled, it helps to look at the neuroscience of depression. Depression is not just a matter of low serotonin or chemical imbalance. It involves underactive neural networks, especially in the prefrontal cortex, which is the part of the brain responsible for decision-making, planning, emotional regulation, and motivation.

Antidepressant medications work on chemical signalling throughout the entire brain and body. They can be extremely effective for some people. But for others, the specific brain regions involved in their depression remain sluggish even when the chemistry improves. This mismatch between chemical support and neural activation helps explain why medication alone may not be enough.

TMS offers a different approach. Instead of influencing the whole brain at once, it delivers magnetic pulses that directly stimulate the areas most involved in mood. Over time, the repeated stimulation increases activity in the prefrontal cortex, strengthens neural pathways, improves communication between brain regions, and supports healthier emotional processing.

Many people describe TMS as giving their brain “a kick-start”, a targeted reboot that medication could not accomplish on its own. This may be why:

• Medication modifies the chemistry. This matters because medication improves neurotransmitter levels across the whole brain, but it cannot directly activate the specific underactive circuits driving depression.

  
  

• TMS activates the circuitry. In other words, TMS targets and stimulates the exact brain regions that remain sluggish despite medication, helping restore healthy neural activity and emotional regulation.

  
  

Together, they can create a far more complete foundation for recovery.

What the Treatment Journey Looks Like at Neuromed

Starting TMS can feel unfamiliar at first, but the process is structured, predictable, and carefully supported by the clinical team.

The journey begins with a thorough assessment.

During this appointment, your clinician will explore your mental health history, previous treatment attempts, current symptoms, medical background, and any co-existing conditions such as anxiety or ADHD. The aim is to gain a deep understanding of your experience and determine whether TMS is the right option. This is also a chance for you to ask questions and express any concerns, whether practical or emotional.

Motor threshold mapping

Once the assessment is complete and you decide to proceed, the next step is motor threshold mapping. This is a painless, one-time session used to identify the precise intensity and location for your treatment. A series of gentle magnetic pulses are delivered to a specific part of your brain, allowing the clinician to calibrate the device to your unique physiology. Most people find mapping slightly unusual but not uncomfortable.

Treatment sessions

Treatment sessions begin shortly thereafter. A typical course involves 20–36 sessions, usually scheduled five days a week. Each session takes around 15–20 minutes. You sit comfortably in a reclined chair while a small coil rests lightly against your scalp. The device emits rhythmic tapping sensations and clicking sounds, similar to a woodpecker tapping on a tree. You remain fully awake and can listen to music or talk with your technician. There is no sedation, no cognitive impairment, and no downtime afterward. Most people drive themselves home or head straight back to work.

Monitoring and adjustment

Throughout your TMS course, the Neuromed team checks in regularly to monitor your progress. You may notice subtle changes early on such as improved sleep, more energy, greater mental clarity, or a softening of anxious thoughts. Others feel shifts more gradually, perhaps by week three or four. Each brain responds differently, and your clinician will guide any necessary adjustments to keep your treatment on track.

End of treatment review

At the end of the course, you’ll have a review session to evaluate your progress, celebrate gains, and decide on next steps. Some people need no further treatment. Others benefit from occasional maintenance sessions to reinforce progress during stressful times. The goal is always long-term stability and improved quality of life.

How Effective Is TMS?

TMS has been extensively studied and is now considered a standard treatment for depression worldwide. Most people with treatment-resistant depression experience significant improvement. Many achieve full remission. While no treatment can guarantee recovery, the success rates of TMS are encouraging.

Real-world outcomes often echo the research. Patients describe feeling lighter, more present, more motivated, and more themselves. They report being able to think clearly for the first time in months or years. They reconnect with hobbies, relationships, and meaningful activities. Their emotional range becomes richer, and their energy more consistent. For many people, TMS represents not just symptom relief, but a genuine return to themselves.

Is TMS Safe?

One of the major benefits of TMS is its safety profile. Because the treatment does not involve systemic medication, it avoids common side effects such as weight changes, emotional numbness, nausea, sedation, or cognitive fog. Most people tolerate TMS extremely well. The most common side effect is mild scalp discomfort or headache during the first few sessions, which usually fades quickly.

There is no impact on memory, thinking ability, or alertness. You can drive, work, study, or care for family immediately after each session. This makes TMS particularly helpful for people who cannot afford downtime or additional cognitive strain.

Who Can Benefit From TMS?

TMS is especially helpful for people who feel they’ve reached the limits of what medication alone can offer. Many individuals come to TMS after trying several antidepressants with little improvement, or after experiencing side effects that interfere with daily life.

Others want to explore a treatment that works directly on the brain’s circuits rather than relying solely on chemical changes. TMS can also be a meaningful option when depression is complicated by anxiety, emotional dysregulation, or ADHD-related mood challenges, where symptoms tend to overlap and reinforce one another.

People who may benefit most include those who:

• have tried multiple antidepressants without success,

• experience side effects that are difficult to tolerate,

• want to reduce their medication load,

• prefer a non-pharmacological or brain-targeted approach,

• struggle with depression linked to anxiety or emotional reactivity,

• live with ADHD-related emotional or motivational difficulties,

• or feel stuck in a long-standing depressive pattern.

  
  

In addition, TMS can be helpful for individuals dealing with persistent fatigue, low motivation, or brain fog, even when these symptoms have not responded to medication.

A Take-Home Message

TMS is not a last resort, it is a powerful, evidence-based treatment for people whose depression has been resistant to medication. It works by stimulating the brain circuits responsible for mood, offering a targeted and effective intervention without the side effects of medication. If you or someone you love has been stuck in a long cycle of depression, TMS may offer a new path forward. With a personalised assessment and a supportive clinical team, healing is not only possible, but also within reach.

For more information, or to book an assessment, please contact us today.

Meet Dr. Susan McGarvie, Ph.D.

Mindfulness-Based Therapist, Writer, Researcher

Dr. Susan McGarvie is a qualified Mindfulness-Based Therapist with over twenty years of healthcare experience and specialised training in mindfulness and positive psychology. Dr. McGarvie writes blog content for Neuromed Clinic, drawing from her extensive clinical knowledge and real-world experience to provide evidence-based insights and authentic, expert-driven content. Her approach combines professional expertise with practical understanding, ensuring you receive guidance from a practicing healthcare professional. Dr. McGarvie is also available to provide online mindfulness therapy sessions for adults over the age of 18.