Everything you need to know about Should You Stay on Antidepressants During TMS? — how it works, what it costs, and how to find a provider who actually knows what they're doing.
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Most people stay on their antidepressants while they do TMS, and clinics treat them that way every day. TMS is usually offered after antidepressants haven’t worked well enough, and the research on combining the two is better than many people expect. Still, whether you keep, adjust or stop a medication is a decision for your prescriber, not something to work out alone. Don’t stop or change a dose on your own because you’ve started TMS. This guide explains what we know so you can have an informed conversation with your doctor.
Key takeaways
- The pivotal NeuroStar trial that led to TMS being offered for depression enrolled people who were medication-free. In practice, many people do TMS while on antidepressants.
- A 2024 meta-analysis of randomized trials found that adding rTMS to an SSRI worked better than the SSRI plus sham stimulation. It found no added benefit for SNRIs, but that rests on a small number of trials.
- Bupropion is not treated as a reason to avoid TMS, though your clinic should know about it.
- Some medicines raise seizure risk or may blunt response. Your TMS clinic and prescriber should review your full list before you start.
- If you improve, you may still need medication afterward. Plan that with your prescriber.
Why this question comes up
TMS is typically offered to people with depression who haven’t improved enough on medication. The FDA clearances are written that way: BrainsWay’s Deep TMS clearance, for example, refers to adults who failed to achieve satisfactory improvement from previous antidepressant medication in the current episode. So the real question usually isn’t “TMS or medication.” It’s what to do with the medication you’re already taking while TMS starts.
The original trials add to the confusion. O’Reardon and colleagues’ 2007 trial tested TMS in 301 medication-free patients. That’s a research design, not an instruction to stop your medication. NeuroStar’s own safety information notes that TMS has not been studied alongside antidepressants in controlled trials, though it has been given safely with them.
What research shows on combining the two
SSRIs and SNRIs
A 2024 systematic review and meta-analysis in EClinicalMedicine pooled randomized trials that gave an antidepressant along with real or sham rTMS. It covered 14 articles and 848 people. The findings:
- SSRIs plus rTMS produced lower depression scores and higher response and remission rates than SSRIs with sham rTMS.
- SNRIs plus rTMS showed no additional benefit over SNRIs with sham.
- Only SSRIs and SNRIs had enough trials to analyze. The authors note high variability in some results, partly driven by one SSRI trial with a large effect.
A second 2024 meta-analysis of 18 trials (1,357 people, 11 using rTMS) found that brain stimulation added to antidepressants beat antidepressants alone for depression symptoms right after treatment, but the advantage wasn’t clear at follow-up. It also found the combination did not clearly improve anxiety, and it said long-term data are lacking.
The honest summary: combining looks helpful, particularly with SSRIs, but the number of trials is small and the long-term picture is unclear. Please don’t read the SNRI result as “SNRIs don’t work with TMS.” It means there wasn’t enough trial evidence to show added benefit.
Bupropion (Wellbutrin)
Bupropion carries a seizure warning on its own label, so people worry about stacking it with TMS. A systematic review of 25 TMS-induced seizures found that none involved a patient taking bupropion. It identified sleep deprivation, taking several medications, and prior neurological injury as risk factors, and concluded the data don’t support treating concurrent bupropion as a reason to be excluded from TMS. The authors also say risk factors should be screened and discussed during consent.
Tricyclics and older antipsychotics
NeuroStar’s safety information lists tricyclic antidepressants and neuroleptic medications among the concurrent medications that may raise seizure risk. If you take one of these, your clinic will want to talk it through with your prescriber before starting.
Benzodiazepines and stimulants
Benzodiazepines (often prescribed for anxiety or sleep) aren’t antidepressants, but many people on antidepressants take them. In an observational study of 181 people having TMS, benzodiazepine users had lower response at six weeks (16.4% versus 35.5%), while stimulant users had higher response (39.2% versus 22.0%). The authors cautioned that the results weren’t corrected for multiple comparisons and need to be replicated. This is a signal, not proof, and it is not a reason to stop a benzodiazepine yourself. Some of these drugs can cause serious problems if stopped suddenly.
A quick reference
| Medication | What research or labeling says | Who decides |
|---|---|---|
| SSRIs | Added benefit with rTMS in a 2024 meta-analysis | Prescriber and TMS clinic |
| SNRIs | No added benefit shown in available trials, which are few | Prescriber and TMS clinic |
| Bupropion | No seizures among 25 reported TMS seizures in one review. Not considered a reason to exclude | Prescriber and TMS clinic |
| Tricyclics, neuroleptics | Listed by NeuroStar as raising seizure risk | Prescriber and TMS clinic |
| Benzodiazepines | Linked to lower response in one observational study. Needs replication | Prescriber only |
What to talk to your doctor about
Bring your complete list: prescriptions, doses, supplements, and anything you take as needed. Then ask:
- Should I keep my medications exactly as they are during the TMS course?
- Is any medication I take on the seizure-risk list your clinic uses?
- If TMS works, how long should I stay on my antidepressant afterward?
- If I’m doing poorly, who decides whether to change a medication, you or the TMS psychiatrist?
- Should anything about my sleep, caffeine or alcohol change while I’m on these medicines? See our post on TMS and alcohol.
If you’re not sure how to raise this, our guide on how to talk to your psychiatrist about TMS has scripts.
Don’t stop abruptly
Some antidepressants cause withdrawal-like symptoms when stopped suddenly, and stopping can bring depression back. You also won’t be able to tell whether TMS or the medication change caused any shift in how you feel. If you and your prescriber decide to taper, they can plan a schedule. TMS clinics can coordinate with your prescriber, and many have psychiatrists on staff.
After the course
TMS doesn’t always last forever. NeuroStar’s safety information notes that patients may need to resume antidepressant medication after the acute course, since the lasting effect hasn’t been tested in controlled trials. Our guides to maintenance TMS and signs of depression relapse cover what to watch for.
Other treatments at the same time
If you’re also considering ketamine or esketamine, read TMS and ketamine together. For a side-by-side with medication alone, see TMS vs medication.
Next steps
If medications haven’t given you enough relief, find a TMS clinic near you and ask what their psychiatrist will review before you start. You can also take the two-minute candidate quiz to see whether TMS is worth discussing with your doctor.
This article is general information, not medical advice. Talk to your prescriber before making any change to your medication.
Frequently asked questions
Do I have to stop my antidepressant to start TMS?
No. Most people don’t stop. TMS is typically offered to people who haven’t improved enough on medication, and many do the course while still taking it. Whether to adjust anything is something your prescriber and TMS psychiatrist should decide with you.
Does TMS work better with an antidepressant?
Possibly, with SSRIs. A 2024 meta-analysis found that rTMS plus an SSRI beat an SSRI plus sham stimulation. The trials were few and varied, and SNRIs didn’t show added benefit. It’s not a reason to start or switch a medication without your doctor.
Is it safe to do TMS while taking bupropion?
A review of reported TMS seizures found none among people taking bupropion, and it concluded the data don’t support excluding people on it. Your clinic should still know about it, and they’ll screen for other seizure risks such as sleep deprivation and alcohol.
Can I lower my dose once TMS starts working?
Maybe, but that’s a conversation with your prescriber, not a step to take alone. They may want to wait until the course is finished and your improvement is stable.
Will I need to stay on medication after TMS?
Some people do. Relapse after TMS can happen, and maintenance options exist. Ask your prescriber what a sensible plan looks like for you.
What if I’m not on any antidepressant right now?
That’s fine too. The pivotal trials enrolled medication-free patients. Some people are intolerant of medication or choose not to take it. Your clinic will review your history and decide whether TMS makes sense.
