If you’ve tried two, three, maybe four antidepressants and none of them got you all the way better, you already know what that feels like. You didn’t do anything wrong. You took the medication, you showed up for therapy, you waited the weeks everyone said to wait. The depression is still there.
Here’s the part no one says often enough: when pills keep missing, the problem usually isn’t you. It’s that another pill in the same family is less likely to work than the last one. There’s a name for this (treatment-resistant depression, or TRD), and there’s a treatment that works completely differently called TMS. It doesn’t go through your stomach or your bloodstream. It uses gentle magnetic pulses to wake up the part of the brain that controls mood, right there in a chair, in about 20 to 40 minutes a day.
If you’re looking at TMS in Manhattan, the question worth asking isn’t “does TMS work?” It’s “which kind of TMS is right for me?” There are four main types, and they’re not all the same. This guide walks through them in plain language, explains what to expect, and tells you what to look for in a provider so you can make a good choice, wherever you end up getting care.
Nushama’s care team can walk you through this in person, and the rest of this article gives you the background to come to that conversation prepared.
Why medications stop working (and why that isn’t your fault)
The biggest study ever done on depression treatment is called STAR*D. It followed thousands of people through one antidepressant after another to see what happens when the first one doesn’t work. Here’s what they found:
After the first antidepressant, about 37% of people felt fully better. After a second try, the number dropped to about 31%. By the fourth medication, it was down to around 13% (Rush et al., 2006). In other words, each new pill in the same family is less likely to help than the last one.
That’s a frustrating pattern if you’re the one living it. It’s also useful information, because it points to a specific answer: when medications keep missing, you usually need a treatment that works through a different path. TMS is one of those.
What “treatment-resistant depression” means in plain English
Doctors say you have treatment-resistant depression, or TRD, when you’ve tried at least two different antidepressants (each one long enough, at a full dose) and neither of them lifted the depression. It is not a label that says you’re harder to help. It just means the next step should probably be a different kind of treatment, not another pill.
One thing worth knowing: not all TRD is the same. Someone who’s tried two SSRIs is in a different spot than someone who’s tried four medications plus ECT. That’s why a good TMS evaluation starts with a careful look at your full treatment history, so the plan actually fits where you are.
The four kinds of TMS, in plain language
TMS (transcranial magnetic stimulation) works by using a coil placed gently against the side of your forehead to send short magnetic pulses into an area of the brain that helps regulate mood. The pulses aren’t painful (most people describe them as a tapping feeling), and you stay fully awake the whole time. No anesthesia, no medication, no recovery period afterward. You can drive yourself home and go back to work.
There are four main flavors. They all use the same basic idea, but they differ in how long each session takes, how many sessions you need, and who they tend to work best for.
| Type of TMS | How long is each session? | How many weeks? | Who it tends to fit |
|---|---|---|---|
| Standard rTMS | 30–40 minutes | 6 weeks, 5 days a week | The most studied option; a good starting point for many people |
| iTBS (theta-burst) | 3–10 minutes | 6 weeks, 5 days a week | People who need shorter appointments or can’t take long time off |
| Deep TMS (H1 coil) | About 20 minutes | 4 to 6 weeks, 5 days a week | People who’ve tried antidepressants and need a stronger stimulation field |
| SAINT/SNT (accelerated) | About 10 minutes, but 10 sessions a day | 5 days total | People who need results fast |
Standard rTMS (the original)
This is the version that’s been around the longest and has the most research behind it. You come in once a day, five days a week, for about six weeks. Each session is 30 to 40 minutes. In a large real-world study of 307 patients, about 58% of people responded and roughly 37% reached full remission (Carpenter et al., 2012; O’Reardon et al., 2007). The main downside is the time commitment.
iTBS (the shorter version)
iTBS is a newer pattern of pulses that delivers the same kind of effect as standard rTMS in a fraction of the time. A large trial called THREE-D compared them head-to-head in 414 patients and found iTBS worked just as well, with sessions as short as three minutes. If six weeks of 40-minute appointments sounds impossible, iTBS usually isn’t. You still come in five days a week for six weeks, but you’re in the chair for minutes, not most of an hour.
Deep TMS (the stronger field)
Deep TMS uses a helmet-shaped coil (called the H1) that reaches a little deeper and wider into the brain than the flat coils used in standard rTMS. It’s FDA-cleared specifically for people whose depression hasn’t responded to antidepressants. In a multi-center trial, 37% of people with medication-resistant depression reached remission on active Deep TMS, compared to about 14.5% on the sham (fake) version (Levkovitz et al., 2015).
SAINT/SNT (the fast track)
SAINT is the most intensive option. Developed at Stanford, it compresses the whole course into just five days, with 10 short sessions per day. In the small controlled trial that led to FDA clearance (Cole et al., 2022, 29 participants), 78.6% of people with treatment-resistant depression reached remission. It’s designed for severe cases that need relief quickly, and it’s only offered at certain clinics. If time is the deciding factor, this is the option to ask about.
What to look for in a Manhattan TMS provider
Manhattan has a lot of places that offer TMS, from big hospital systems to small specialty clinics. Rather than comparing them to each other, here are the things actually worth asking whoever you see. The answers will tell you whether the care fits what you need.
Do they offer more than one kind of TMS? Standard, iTBS, Deep TMS, and SAINT aren’t interchangeable. A team that can evaluate which one fits your history is more helpful than one that only offers the version they happen to have.
Can they add ketamine or Spravato if TMS isn’t enough? About half the people who try TMS don’t reach full remission from it alone. Having Spravato or IV ketamine available in the same place means you don’t have to start over somewhere new if you need more.
Do they plan for after the course, not just during it? Staying well is as important as getting well. Ask what happens in the 6 to 24 months after treatment ends.
Will they talk to your regular psychiatrist and therapist? TMS works best as part of the rest of your care, not in place of it.
At Nushama, our care approach is built around all four: matching the right kind of TMS to your history, giving you access to Spravato and IV ketamine in the same place if you need them, making a plan for afterward, and coordinating with the people already taking care of you.
What to do if TMS helps but doesn’t fully fix things
About half of people who try TMS feel meaningfully better, and roughly a third reach full remission. Those are real numbers, and they also mean a good portion of people get part of the way there and need something more.
If TMS helps but you’re not all the way back to yourself, here are the common next steps:
- Try a different kind of TMS. Sometimes switching from standard rTMS to Deep TMS or SAINT unlocks more improvement.
- Add ketamine or Spravato. These work through a different mechanism and can be used alongside or after TMS.
- Add therapy. Certain types of talk therapy, especially forms of CBT built for depression, tend to work better once TMS has lifted the fog enough for you to engage.
- Consider ECT if the depression is severe. ECT is still the single most effective option for severe depression, with response rates around 60 to 80%. Most people try TMS first because it doesn’t require anesthesia, doesn’t affect memory, and lets you go back to your day.
The practical thing to think about is whether the place you pick can actually walk the whole road with you. At Nushama, that’s how we’ve built the pathway: if TMS is partial, we can adjust the type, layer in Spravato or ketamine therapy, and work alongside your outpatient team without asking you to start your story over.
How Nushama approaches longer-term depression
When depression has been around for years and has resisted more than one medication, the care plan has to do more than just “run a course of TMS.” At Nushama, that plan usually includes:
- A full evaluation of your treatment history, so the plan is built for where you are right now
- Choosing the kind of TMS that best fits your specific situation, rather than a one-size-fits-all default
- Staying in touch with your regular psychiatrist and therapist
- Having Spravato or ketamine available in the same place if TMS alone isn’t enough
- A plan for staying well, including ongoing TMS support for the 6+ months after your course
The point is ongoing care, not a single treatment episode. When the depression has resisted a lot of things already, the plan should expect that the first step may not do everything on its own.
The real question isn’t “will TMS work?” It’s “which kind fits me?”
If you’ve been through medication after medication, the STAR*D data is actually reassuring: it says what happened isn’t a reflection of you. Each pill in the same family is less likely to work than the last. That’s why changing the approach (not just trying one more pill) tends to be what finally breaks the pattern.
TMS is one of those different approaches. Picking between six weeks of standard sessions, three-minute theta-burst sessions, a deeper-reaching coil, or a five-day intensive is a decision that depends on your history, how severe things feel, and what your life can handle right now.
Start with a team that will look at your whole picture and offer more than one path. If you’d like that conversation with a team that also offers ketamine, Spravato, and long-term planning, book a consultation with Nushama.
FAQs
What is the success rate of TMS for treatment-resistant depression?
In everyday clinical practice, about 50 to 60% of people feel meaningfully better on TMS, and 30 to 40% reach full remission (Carpenter et al., 2012). The fast-track SAINT/SNT protocol reached 78.6% remission in a small controlled trial of 29 participants (Cole et al., 2022), though real-world results can vary.
How long does a TMS treatment course take?
Standard TMS is 30 to 40 minutes per session, five days a week, for about six weeks (O’Reardon et al., 2007). iTBS shortens the session to 3 to 10 minutes on the same six-week schedule (Blumberger et al., THREE-D trial, 2018). SAINT/SNT compresses the whole course into five days (Cole et al., 2022).
Is TMS better than ECT for treatment-resistant depression?
ECT is still the most effective single treatment for severe depression, with response rates around 60 to 80%. Most people try TMS first because it doesn’t require anesthesia, doesn’t affect memory, and doesn’t interrupt your daily life. If TMS doesn’t get you all the way there, ECT may be a reasonable next step depending on how severe things are.
Can TMS be combined with ketamine or Spravato?
Yes. Some clinics, including Nushama, offer TMS alongside Spravato (esketamine) or IV ketamine as part of a combined plan. There’s growing evidence that combining these treatments can help people who only partially responded to one.
This article is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making decisions about your care.
