Can TMS Be a Bridge When Medication Isn’t Working?

Sam Clinch • December 11, 2025

What is “treatment-resistant depression” (TRD)?



Clinically, TRD is commonly defined as depression that has not sufficiently responded to an adequate trial of two different antidepressants (from at least two different classes) given at therapeutic doses and durations. Some insurers and clinical guidelines use this “two-trial” rule when deciding whether to cover advanced treatments like TMS. Medicare and commercial payers may have slightly different wording (for example, Medicare sometimes requires one failed antidepressant; Anthem often requires two). The key idea is consistent: TRD means standard medication strategies haven’t produced an acceptable response.

Why do medications sometimes fail?



Antidepressants help many people, but there are several reasons they may not work for someone:



  • Different biology: Antidepressants act primarily on neurotransmitter systems (serotonin, norepinephrine, dopamine). Depression is heterogeneous - for some people, symptoms reflect maladaptive brain-circuit function that medications don’t adequately correct.


  • Side effects & tolerability: Some people cannot tolerate the side effects of medications at effective doses.


  • Partial or transient responses: A medication may help a little (or briefly) but not produce sustained remission.


  • Complex or comorbid conditions: Co-occurring anxiety, PTSD, medical conditions or bipolar spectrum features can blunt medication response.



Because these issues are common, clinicians consider alternative mechanisms of treatment - therapies that act on the brain in different ways. TMS is one of those options. (Ketamine/esketamine is another; the treatments can be complementary rather than mutually exclusive.)


How is TMS different from medication?




TMS uses a magnetic coil placed over the scalp to directly stimulate specific cortical regions (commonly the dorsolateral prefrontal cortex for depression). Repeated stimulation over days to weeks produces enduring changes in brain circuits (neuroplasticity), helping underactive networks regain healthier patterns. This circuit-based approach is biologically distinct from the way antidepressants modulate neurochemistry, which is one reason TMS can help people whose depression did not respond to medications. TMS is non-invasive, performed outpatients, and does not produce systemic medication side effects.

Evidence: Does TMS help people with TRD?



Yes. Large trials and many real-world clinic outcomes show that TMS can produce meaningful responses and remission in patients with TRD. Clinic-level tracking at Inspire and published meta-analyses report robust response rates among patients who previously failed multiple medication trials. Importantly, many people who respond to an initial TMS course will also benefit from retreatment or maintenance if symptoms recur - so TMS can be both an acute and a long-term tool. 

What does a TMS care pathway typically look like?



  • Consultation & screening. A TMS-trained psychiatrist reviews your history, past medication trials, suicidality risk, and safety (metal implants, seizure history). Clinics usually collect objective symptom measures (PHQ-9) to track progress.


  • Mapping & first session. The physician performs a mapping procedure to find the ideal stimulation site and the right intensity for you. The first treatment often follows mapping.



  • Monitoring & maintenance. Progress is tracked and, if needed, maintenance or booster sessions are offered to sustain benefit. Clinics also discuss integrating medication/therapy as part of ongoing care. 



Safety & tolerability - what to expect


TMS is generally well tolerated. The most common side effects are transient scalp tenderness or mild headache. Serious events (like seizure) are very rare when screening is done correctly. TMS is routinely favored for patients seeking non-systemic treatment without anesthesia, and clinics explicitly compare its safety and tolerability favorably to more invasive neuromodulation like ECT. Nonetheless, careful screening and ongoing monitoring are standard. 


Where TMS fits with other advanced options (ketamine, ECT, residential)


Ketamine / Spravato:

These can provide rapid relief for some patients and are useful in crisis or when rapid reduction of suicidal ideation is needed. However, effects may be transient for some people. TMS can be complementary - ketamine for rapid rescue and TMS for durable circuit retraining. Clinicians often design a sequence or combine approaches depending on needs.


ECT:

Still the most effective option for some severe, refractory depressions, but it requires anesthesia and carries additional recovery considerations. TMS is a less invasive option with an excellent tolerability profile and can be considered for those reluctant to pursue ECT. A clinician will help weigh risks/benefits.


Residential care:

Important for stabilization and intensive psychotherapy. If symptoms persist after residential treatment, TMS is a logical brain-directed next step to consolidate gains or treat residual biological symptoms. 

Who is most likely to benefit?


People with clearly documented TRD - those who have tried adequate antidepressant courses (and often psychotherapy) without sufficient response - are primary candidates. Partial responders to other treatments, people unable to tolerate medication side effects, or those who prefer a non-drug intervention are also common candidates. Adolescents (age 15+) may be considered in selected circumstances with careful evaluation. A psychiatrist experienced in TMS will determine candidacy after a comprehensive review. 


Download Your Roadmap to TMS


Want a clear picture of what to expect? Download the TMS Treatment Roadmap by Sydney


What about insurance & access?


Most major commercial insurers, Medicare and Tricare cover TMS for treatment-resistant major depressive disorder when plan criteria are met and prior authorization is obtained. Coverage details vary - insurers typically require documentation of medication trials, severity measures (PHQ-9), and a psychiatrist’s letter of medical necessity. Accelerated protocols and off-label indications (some anxiety/PTSD uses) are often not covered; clinics offer sliding-scale or self-pay options for those cases. Always ask the clinic to run a benefits check and provide an itemized estimate.

Patient stories & real-world hope


Clinic reviews and patient accounts often describe people who finally achieved meaningful recovery with TMS after long medication trials, ketamine courses, or residential stays. These stories don’t guarantee outcomes, but they reflect clinical experience: TMS can produce substantial, durable improvements for many people who have struggled for years. Inspire’s outcome tracking supports these real-world successes.

How to explore TMS as a bridge (practical next steps)



  1. Collect your treatment history. List antidepressants tried (names/dates/doses), any ketamine/Spravato treatments, psychotherapies and residential programs, and recent symptom scores (PHQ-9).
  2. Request a TMS consult. A TMS psychiatrist will review your record, screen for safety, and explain likely benefits and realistic expectations. Inspire offers phone consultations and runs benefits checks.
  3. Discuss sequencing. If you’ve had recent ketamine or other interventions, ask how TMS could be sequenced or combined to maximize durability of benefit.
  4. Plan for mapping & course. If you proceed, expect a mapping session and a personalized plan (standard, iTBS or accelerated) with clear monitoring and a maintenance strategy if you respond. 



Learn More: TMS Therapy


  • I tried many meds and ketamine without lasting benefit. Should I try TMS?

    Yes - different biological mechanisms mean TMS can work when other treatments did not. A TMS psychiatrist can assess your history and recommend a personalized plan.

  • How soon will I feel better?

    Responses vary. Some patients notice improvements in 1–3 weeks; many reach substantial benefit by 6–8 weeks. Accelerated protocols may speed effects for selected patients.

  • Is TMS safe if I’ve had ECT or ketamine?

    TMS can be used after other treatments, including ECT and ketamine, but decisions depend on your clinical history. Your psychiatrist will assess safety and sequencing.

Every Question Answered

Want to know more about TMS? Check out this in-depth guide to TMS therapy with transparent and easy to understand explanations about TMS processes, protocols, and treated conditions.

Latest Posts

By Sam Clinch December 12, 2025
What Inspire TMS Denver accepts and what that means In-network / insurer relationships: Inspire states it accepts major commercial insurers and works with patients to obtain coverage - including Medicare and Tricare, where criteria are met - and the clinic routinely runs benefits checks and prior authorizations on a patient’s behalf. That means you don’t need to guess whether a policy will pay - Inspire will verify for you. Common Medicare / commercial rules (examples): Different payers have specific clinical criteria. For example (from the clinic’s pricing documents): Anthem - typically requires failure of two different antidepressants from different classes (or intolerance). Medicare -may require failure of one previous antidepressant (or intolerance) Tricare - covers TMS when it is medically necessary and prior less-intensive interventions have failed or are inappropriate. These examples illustrate typical insurer frameworks, but your plan may differ. What’s often covered vs not covered: Commonly covered: FDA-cleared TMS for treatment-resistant major depressive disorder when prior treatment criteria are met and prior authorization is approved. Often not covered (or considered “off-label”): accelerated TMS protocols , certain indications (some anxiety/insomnia/experimental uses), and some PTSD/anxiety uses; these may require self-pay or sliding-scale payment. Inspire notes it offers sliding-scale/self-pay for off-label care and for financial hardship.
By Sam Clinch December 12, 2025
How TMS is different: a quick, plain-language explanation TMS uses a magnetic coil to stimulate specific areas of the brain associated with mood and emotional control. It’s non-invasive, does not require anesthesia, and is performed in an outpatient setting. Instead of changing chemistry like antidepressants or providing a rapid but medication-based reset like ketamine , TMS aims to retrain brain circuits by repeatedly activating under-performing regions so they function more normally over time. Inspire’s patient materials stress this neuroplastic, circuit-based approach and describe mapping, stimulation and physician oversight used to personalize treatment.
By Sam Clinch December 10, 2025
Your main options while you’re in Colorado Short/accelerated courses If you have very limited time, accelerated TMS (iTBS or compressed protocols) lets clinics deliver many sessions over a few days rather than weeks. Inspire offers accelerated regimens (MagVenture-capable) and lists accelerated TMS as an option for patients who need a fast course, but note: accelerated courses are often not covered by insurance and usually require self-pay or sliding-scale arrangements. Maintenance or “rescue” sessions Maintenance or “rescue” sessions If you’ve completed a full course and need occasional boosters to maintain gains while away, maintenance TMS (weekly, biweekly, or monthly sessions) is common. Clinics also provide rescue or extension courses when symptoms re-emerge. Maintenance often requires a clinician discussion to set frequency, and many insurers do not routinely cover maintenance so clinics may offer packages or discounted session bundles. Full course continuation If your original acute course was interrupted, many clinics will pick up or adjust your plan; this typically requires review of previous mapping and progress measures and coordination with your home TMS provider. Inspire performs mapping and tailors plans to each patient’s needs.
Soldiers in uniform seated in a circle; one person comforts another, all in a support group setting.
By Sam Clinch December 9, 2025
Short answer: Yes — Transcranial Magnetic Stimulation (TMS) is increasingly used to treat PTSD symptoms, and many patients report improvements in intrusive memories (flashbacks), hypervigilance and reactivity. At Inspire TMS Denver we tailor TMS protocols to each person’s needs and monitor results closely, offering standard and advanced TMS options for trauma-related symptoms.
Woman in blue scrubs smiles in front of an
By Sam Clinch December 9, 2025
Who is this page for? If you’re searching “ TMS therapy near me ” because medications or therapy haven’t worked, this guide walks you through what TMS is, the types of TMS offered at Inspire TMS Denver, who qualifies, what a typical course looks like, cost & insurance realities, and real patient experiences so you can decide whether to book a free consultation. Inspire is a doctor-led clinic that specializes in evidence-based TMS and personalized care.
By Sam Clinch November 20, 2025
Recognizing the Signs of Bipolar Disorder Bipolar disorder is often misunderstood or misdiagnosed due to its fluctuating nature. Common signs include: Periods of extreme energy or euphoria (mania or hypomania) Sudden shifts to sadness, fatigue, or hopelessness (depression) Difficulty concentrating or making decisions Sleep disturbances (sleeping too much or too little) Impulsive or risky behavior Feelings of irritability or agitation  While everyone experiences mood shifts occasionally, those with bipolar disorder often find these changes disruptive to work, relationships, and daily life.
By Leo Cook November 18, 2025
If you’re struggling with depression, you’re not alone - and you’re likely asking: What actually works? That’s where TMS (Transcranial Magnetic Stimulation) enters the conversation. Let’s break down how effective TMS really is - nationally and here at Inspire TMS Denver .
By Sam Clinch November 18, 2025
Understand Eligibility, Insurance, and Whether TMS Might Be Right for You
By Sam Clinch November 18, 2025
How Inspire TMS Denver Can Help You Continue or Restart Your TMS Journey
By Sam Clinch November 18, 2025
A step-by-step guide to beginning your TMS treatment journey at Inspire TMS Denver
Show More