Some people are able to reduce or stop taking antidepressants during or after transcranial magnetic stimulation (TMS), but this should only be done under medical supervision. Others continue their medication, either at the same dose or a lower one, depending on their history of depression, symptom severity, and risk of relapse.

Most People Stay on Antidepressants During TMS

In clinical practice, most patients continue their antidepressants while undergoing TMS. There is no requirement to stop medications unless a provider identifies a specific concern.

Here’s what typically happens during treatment:

• Some patients stay on their current dose throughout the TMS course.
• Others may adjust their dose slightly to minimize side effects or improve mood regulation.
• A few may reduce medications gradually after TMS if symptoms improve dramatically.

Combining both treatments does not interfere with results. On the contrary, some research suggests the combination may accelerate symptom relief (1).

TMS Can Also Work Without Antidepressants

TMS is FDA-approved as a standalone treatment for major depressive disorder (MDD), particularly in people who have not improved with medications.

• TMS targets specific brain circuits involved in mood regulation, especially the left dorsolateral prefrontal cortex, which is often underactive in depression.

• Antidepressants affect brain chemistry system-wide, while TMS works locally on brain activity.

• This difference makes TMS especially effective for treatment-resistant depression.

Research shows that:

• More than 60% of treatment-resistant patients respond to TMS (2).
• About one-third reach full remission after completing the course of their treatment (3).

What Does the Research Say About Combining TMS and Antidepressants?

A recent systematic review and meta-analysis found that patients receiving both antidepressants and TMS had better outcomes than those using either treatment alone (4).

• Across 10 randomized trials and 20 add-on studies, people who had real TMS while on antidepressants reported greater symptom improvement and higher remission rates compared to medication-only or sham TMS.

• Experts believe the treatments work synergistically: antidepressants influence brain chemicals, while TMS reactivates specific brain circuits.

Although more studies are needed to fine-tune timing and dosing, the evidence shows that TMS plus antidepressants often produces stronger results.

When Is It Safe to Adjust or Stop Antidepressants with TMS?

Tapering off antidepressants must always be done gradually under medical supervision. The decision depends on: 

• Full remission after TMS: If symptoms have been gone for at least 3–6 months and the patient is functioning well.
• Troublesome side effects: When antidepressants cause weight gain, sexual dysfunction, fatigue, or emotional blunting.
• Desire for fewer medications: Some patients prefer to reduce long-term medication use once they feel better.
• Lack of medication benefit: If the antidepressant hasn’t helped despite an adequate dose and duration.
• Adverse reactions during TMS: Some patients experience heightened agitation, dizziness, or other side effects that worsen with stimulation.
• Sensitivity to combined treatment: If combining TMS with certain medications triggers discomfort or overstimulation.

On the other hand, some patients may benefit from staying on medication, especially if they have had past relapses, partial TMS response, or find antidepressants provide addtional mood stability.

Risks of Stopping Antidepressants Too Soon.

Abruptly stopping antidepressants can cause discontinuation syndrome, a condition marked by withdrawal-like symptoms, including:

• Dizziness or “brain zaps”
• Nausea and headaches
• Anxiety, agitation, or irritability
• Insomnia and vivid nightmares
• Mood swings and emotional instability

To avoid these this, patients should: 

• Wait until mood has been stable for several months after TMS.

• Taper slowly, over weeks or months.

• Stay in close contact with their psychiatrist and TMS provider.

Do Antidepressants Interfere With TMS Results?

No, antidepressants do not interfere with TMS results. In fact, research suggests they may enhance them (5). The idea that you must choose one or the other is a myth. They’re not opposing forces. Instead, many patients achieve the best results when used together, particularly during the early stages of recovery.

What If I Want to Use TMS Instead of Antidepressants Long-Term?

Some patients prefer to avoid using long-term medication and instead maintain their progress with ongoing TMS sessions.  In this case, there are two options: 

• Preservation TMS: Begins right after the acute phase, often once a week or every two weeks, to prevent symptoms from returning. 
• Maintenance TMS: Sessions are restarted only if symptoms return

These strategies offer a research-backed way to stay well without long-term medication (6).

Talk to Us About Life Beyond Medication

At the TMS Institute of Arizona, we know that treatment must be personalized to the patient. 

Some of our patients have successfully tapered off antidepressants after TMS. Others continue using both for long-term stability. Treatment isn’t one-size-fits-all. That’s why we develop care plans based on each person’s history, progress, and goals.

Our clinical team includes board-certified psychiatrists with deep experience in TMS and medication management. We coordinate closely with your prescribing provider to make sure every decision supports your long-term mental health.

You don’t have to figure this out alone. We’ll walk you through your options, answer every question, and support you through every phase of care.

Located in Scottsdale, Arizona,  we welcome new patients from across the Phoenix Valley.  Call us to schedule a consultation. Let’s talk about research backed possibilities;guided by expertise, and focused on your recovery.

References

1. Gopalkumar Rakesh, Cordero, P., Rebika Khanal, Himelhoch, S. S., & Rush, C. R. (2024). Optimally combining transcranial magnetic stimulation with antidepressants in major depressive disorder: A systematic review and Meta-analysis. Journal of Affective Disorders, 358, 432–439. https://doi.org/10.1016/j.jad.2024.05.037
2. Lew, B. J., Tirrell, E., Fukuda, A. M., Nimalan Murugan, Perez, C., Griffith, W., & Carpenter, L. L. (2025). Identifying Patients with Non-Response for an Extension of TMS Treatments for Depression: A Retrospective Analysis of Clinical Response Conversion. Transcranial Magnetic Stimulation ., 100092–100092. https://doi.org/10.1016/j.transm.2025.100092
3. ‌Stern, A. P. (2018, February 23). Transcranial magnetic stimulation (TMS): Hope for stubborn depression – Harvard Health. Harvard Health. https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335
4. Rakesh, G., Cordero, P., Khanal, R., Himelhoch, S. S., & Rush, C. R. (2022). Combining Transcranial Magnetic Stimulation with Antidepressants: A Systematic Review and Meta-Analysis. https://doi.org/10.1101/2022.11.03.22281857
5. ‌Gopalkumar Rakesh, Cordero, P., Rebika Khanal, Himelhoch, S. S., & Rush, C. R. (2024). Optimally combining transcranial magnetic stimulation with antidepressants in major depressive disorder: A systematic review and Meta-analysis. Journal of Affective Disorders, 358, 432–439. https://doi.org/10.1016/j.jad.2024.05.037
6. Mania, I. (2023, December 14). Long-Term Preservation Transcranial Magnetic Stimulation for Major Depressive Disorder. Psychiatrist.com; Primary Care Companion for CNS Disorders. https://www.psychiatrist.com/pcc/long-term-preservation-transcranial-magnetic-stimulation-major-depressive-disorder/