A Letter from Our TMS Program Director

Here’s some straight, honest talk about depression, antidepressants, and the way in which we use medications to treat depression.

While antidepressants have changed and saved countless lives over the past decades,we simply don’t talk enough about the inexact ways in which we prescribe them, their significant side effects, their limitations, and what happens when they don’t work.

If you have struggled with depression, or love someone who has, you know the process of treating depression with medications is a lengthy and uncertain one characterized by trial and error.  

I share my patients’ frustrations about the limitations of psychiatric medications when treating depression. The hard truth is that antidepressants do not work more often than they do work. Additionally, antidepressants are often associated with systemic side effects including weight gain and sexual dysfunction. So even when they do work, patients can be forced to choose between relief from their depression and a healthy sex life and/or a body they feel  comfortable in.  

It is perhaps best summarized as “throwing spaghetti against a wall to see what sticks”.   

We try one antidepressant and wait four to six weeks. No result? We try increasing the dose, and wait another four to six weeks. No result? We increase the dose again, and wait again. And if all that hasn’t worked, which is statistically likely, it’s time to try an altogether different antidepressant, sometimes needing to take extra time to taper down off the first one. Now on a brand new antidepressant, we start all over again with dose adjustments, again waiting weeks in between each change to see if it worked.  

Many patients repeat this process many times with multiple different antidepressants from different classes. The next step is to try different combinations of these medications, including augmenting antidepressants with small doses of a class of medications rather unfortunately labeled as antipsychotics.  These antipsychotics come with more serious long term health risks such as diabetes and movement disorders.

And as always, we need to wait weeks in between every adjustment to see if it’s effective.

As the number of different antidepressant trials increases, the statistical likelihood of the next one being the one that finally works significantly decreases.

And again, even if we find a combination that helps with mood, we’re left managing potential side effects that can be debilitating.

Why do we put up with this? Why do we keep trying different combinations of medications that too often provide marginal benefit alongside significant side effects? Because for decades, it’s the only choice we had.  

TMS has been a life-altering game changer for those suffering from depression, providing an alternative, drug-free modality of treatment. TMS is not a treatment of last resort, but is recommended as an early option after initial trials of medication haven’t helped. 

 It’s important to note that nothing is a panacea. While the efficacy numbers on TMS are tremendous, they’re not 100%. In certain cases,it makes sense to either stick with antidepressants or try other interventions. 

TMS offers such a terrific combination of high potential benefit and low potential for side effects, that I’m incredibly excited to be able to offer it here at Dana Behavioral Health.

If you are struggling with depression, I hope to see you in my office soon.  

Warm Regards,

Dr. David Robinson