Why Psychiatrists may continue try antidepressant medications when there is a better option

Psychiatrists’ reluctance to prescribe Transcranial Magnetic Stimulation (TMS) after a patient has failed two antidepressants, despite the high success rates shown in studies like the STAR*D study, can be influenced by several factors. 

The first being the concept that medication is the standard of care. Medications have traditionally been the first-line treatment for depression, and prescribing antidepressants is often the default approach, especially given their widespread availability and familiarity. Many psychiatrists are trained primarily in pharmacological treatments and may rely on medications because they are comfortable with their mechanisms, monitoring, and established protocols.

They also may have limited TMS training and familiarity. Not all psychiatrists are trained in administering TMS or are fully aware of its effectiveness, particularly if their primary training was focused on psychopharmacology (drug-based treatment). TMS is still a relatively new tool in psychiatry, and some professionals may hesitate to recommend it due to limited exposure or experience with the treatment. There are approximately 77,000 Psychiatrist in the US and only about 5,000 clinics that offer TMS. From that we can assume that less than 90% of the Psychiatrists are trained or even familiar with TMS. 

Even if TMS is available and covered by insurance, it requires patients to visit the clinic for sessions several times a week over a course of weeks, which some psychiatrists might view as a logistical challenge for patients. This schedule can seem burdensome compared to taking daily medication, and psychiatrists might avoid recommending TMS to reduce possible disruption for patients.

TMS also has a perception of a “Last Resort” therapy. TMS is often seen as a treatment reserved for treatment-resistant depression, usually considered after three or more medications have failed. This perception persists despite evidence that TMS can be effective earlier in treatment. Many psychiatrists still view TMS as a later option rather than something to consider earlier in treatment.

The pharmaceutical industry’s influence on psychiatry cannot be overlooked. Medications are heavily marketed, and doctors may be more exposed to drug-based solutions. This could contribute to a tendency to rely on medication as the go-to treatment, sometimes delaying the use of alternative treatments like TMS.

The mental health field, like any medical field, is sometimes slow to adopt new approaches, especially if they challenge existing treatment standards. The STAR*D study and other research do show the potential benefits of TMS, but many psychiatrists may still rely on multiple medication trials before considering alternative treatments due to ingrained treatment patterns.

In some cases, there is an overreliance on medications. Psychiatry has a long-standing reliance on pharmacological treatments, and the introduction of non-drug options like TMS challenges traditional approaches. However, many psychiatrists are aware of the limitations of medications and are actively exploring or recommending TMS, especially as evidence grows and as more patients demand alternatives.

Psychiatrists open to alternative or combined treatments might be the best fit for patients interested in TMS. With more awareness and better access to TMS, this promising treatment can become an earlier intervention for people struggling with MDD, especially when antidepressants alone are not enough. That is why MDD Care offers you the ability to find Psychiatry clinics that offer TMS and other alternative therapies.