Depression affects millions of people worldwide, and choosing the right treatment can be overwhelming. For decades, antidepressants have been the first-line therapy, but emerging treatments like Transcranial Magnetic Stimulation (TMS) offer a non-medication alternative that avoids many of the common side effects of antidepressants.
Let’s explore how these treatments compare and why TMS might be a better option for some patients.
Antidepressants are medications designed to improve mood by altering the levels of neurotransmitters in the brain, such as serotonin and noradrenaline. The main types include:
SSRIs (Selective Serotonin Reuptake Inhibitors): Sertraline, Citalopram, Escitalopram, Fluoxetine, Paroxetine
SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors): Duloxetine, Venlafaxine
Tricyclics (TCAs): Amitriptyline, Dosulepin, Nortriptyline
Others: Mirtazapine, Trazodone
According to the BBC and NHS sources, antidepressants can cause a range of side effects, some of which can impact daily life significantly:
Mood changes (anger, emotional numbness)
Anxiety or agitation
Sleep problems (insomnia or excessive sleepiness)
Weight gain or loss
Headaches, nausea, or digestive issues
Sexual dysfunction
Heart rhythm changes (palpitations or fast heartbeat)
Withdrawal symptoms if stopped suddenly, including “brain zaps,” dizziness, fatigue, and irritability
A 2025 study from King’s College London and the University of Oxford ranked antidepressants by their physical side effects, revealing that even within the same class, drugs differ markedly. For example:
Agomelatine: ~2.4kg weight loss in 8 weeks
Maprotiline: ~2kg weight gain in 8 weeks
Fluvoxamine: slowed heart rate by 21 bpm
Nortriptyline: sped heart rate by 21 bpm
These side effects can deter patients from continuing medication and may even introduce new health risks, such as heart problems.
Transcranial Magnetic Stimulation (TMS) is a non-invasive, medication-free treatment approved by NICE in 2015 for depression. It uses repetitive magnetic pulses to stimulate brain areas involved in mood regulation, particularly the left prefrontal cortex.
TMS works by inducing neuroplasticity, helping the brain rewire itself and restore normal function in circuits associated with emotional regulation — without relying on chemical changes in the body.
TMS is generally well-tolerated and has far fewer side effects than antidepressants. According to Smart TMS:
Mild headache
Mild fatigue
Very rare risk of seizures (1 in 50,000)
Unlike antidepressants, TMS does not cause weight gain, sexual dysfunction, sleep disturbances, digestive issues, or heart problems. This makes it an attractive option for patients who are sensitive to medication side effects.
| Feature | Antidepressants | TMS |
|---|---|---|
| Mechanism | Alters neurotransmitter levels | Stimulates brain circuits via magnetic pulses |
| Onset of effect | 2–8 weeks | Often 2–4 weeks |
| Administration | Oral, daily | Outpatient sessions (Approx 30 min, daily) |
| Side effects | Anxiety, insomnia, weight changes, sexual dysfunction, heart issues, withdrawal symptoms | Mild headache, mild fatigue, extremely rare seizures |
| Long-term health impact | Possible cardiovascular/metabolic risks | Minimal long-term physical risk |
| Suitability | First-line for mild–moderate depression | Effective for treatment-resistant or medication-sensitive patients |
Non-invasive: No needles, surgery, or anaesthesia required
No systemic side effects: Avoids the weight gain, sexual dysfunction, digestive issues, and cardiovascular risks associated with antidepressants
No withdrawal: Patients can stop TMS without experiencing withdrawal symptoms
Effective for treatment-resistant depression: Offers hope for those who haven’t responded to multiple antidepressants
Improved quality of life: Outpatient sessions allow patients to continue normal daily activities
TMS focuses directly on the brain circuits causing depression rather than flooding the entire system with chemicals. For patients concerned about side effects, TMS provides a compelling, safer alternative.
Both antidepressants and TMS have their place in treating depression. Antidepressants remain a common and accessible first-line therapy, but their side effects and withdrawal challenges can make long-term use difficult.
TMS offers a non-drug alternative with minimal side effects, rapid improvement for many patients, and a targeted approach to restoring healthy brain function. For those who struggle with medication side effects or haven’t found relief with antidepressants, TMS may be the safer, more effective choice.
For those interested in exploring TMS as a treatment option, contact Smart TMS today to discuss your individual needs and find out if TMS could help you. Call 0345 222 5678 to speak with a specialist and arrange a consultation.
Gallagher, J. (2025, October 22). Effects of antidepressants on physical health ranked for first time. BBC News. https://www.bbc.co.uk/news/articles/c9d65nqgd5zo
NHS. (n.d.). Antidepressants. National Health Service UK. https://www.nhs.uk/medicines/antidepressants/
Cipriani, A., Howes, O., & Pillinger, T. (2025). Ranking physical side effects of antidepressants: Analysis of 151 studies. The Lancet. (Referenced in BBC article)