When Antidepressants Don't Work: How a Harvard Medical School-Certified Doctor Treats Depression Without Pills

Millions of people in the United States are taking antidepressants today. According to data Centers for Disease Control and Prevention (CDC) estimates that between 11,4% and 16,6% of adults in the United States take medication for depression or related symptoms. For many, it does help. But sometimes the first medication doesn't work. The second doesn't either. Doctors prescribe a third, change the dosage, add psychotherapy—and the person still feels like life is passing them by.

Fortunately, the capabilities of modern psychiatry do not end there. One method that has been effectively used in the United States in recent years is transcranial magnetic stimulation (TMS)This is a non-invasive treatment for depression and some other disorders that uses magnetic pulses to stimulate areas of the brain responsible for mood control.

In Brooklyn, this method is being put into practice Dr. Igor KirzhnerWith 30 years of experience in psychiatry, a diploma from the American Board of Psychiatry and Neurology, and training at Harvard Medical School, where he studied modern methods for helping patients who have failed standard depression treatments, ForumDaily New York asked Dr. Kirnger to answer the most frequently asked questions about TMS.

What is TMS and why is it needed?

To put it simply, TMS affects the neural networks in the brain involved in mood regulation.

The patient sits in a comfortable chair while a special coil is placed near their head, sending short magnetic pulses to the brain. No surgery, anesthesia, or hospitalization is required. The patient is conscious, can communicate with the doctor, and typically returns to their normal activities immediately after the procedure.

Let's clear up one common misconception: TMS is not "electroconvulsive therapy." It does not induce seizures and has nothing in common with electroconvulsive therapy (ECT).

It hurts?

In short, no. The first procedure is a kind of introduction to TMS. The doctor determines the motor threshold and the individual coil position, and the patient receives the first magnetic pulses. These may cause a slight tingling sensation in the scalp. Some people find this sensation unusual at first, but most quickly become accustomed to it.

How long does one session last?

This depends on the chosen protocol. Standard sessions can last around 20-30 minutes, while modern express protocols take only 3 to 10 minutes. In some cases, longer sessions are chosen to reduce the overall treatment time. However, in general, TMS is not a procedure that requires the patient to spend extensive time in the clinic every day for months.

The doctor decides which protocol is suitable for a particular person after examination.

Why is it important who and how conducts TMS sessions?

When it comes to TMS treatment, it's not just the device itself that matters. Who conducts the sessions, how the protocol is chosen, and the experience of the team caring for the patient all play a huge role.

The same device can be used differently by different practitioners. Treatment outcomes depend largely on the specialist's clinical experience, accurate assessment of the patient's condition, precision in the procedure, and an individualized approach to each case.

TMS isn't just a matter of "inserting a device and performing a session." It's important to properly determine whether the method is suitable for the patient, select the optimal protocol, evaluate changes during treatment, and adjust the strategy if necessary.

Experience is crucial here. The more practical experience a specialist has with TMS, the better they understand how different patients respond to treatment, when a different approach is needed, and what clinical details require attention.

Dr. Igor Kirzhner doesn't operate on a "one-size-fits-all" principle. Each patient is assessed individually: their diagnosis, symptoms, treatment history, previous response to medications, and current condition. It's important not just to complete a TMS course, but to do it correctly.

Therefore, when choosing a location for a TMS procedure, it is important to ask not only, “What kind of device do you have?”, but also:

• Who will carry out my treatment?
• What experience does this team have?
• How is my protocol selected?
• Who will monitor my condition and results?

Technology is important. But experience and the right approach make it a truly effective treatment tool.

Who can TMS help?

Transcranial magnetic stimulation is worth trying for people with depressive disorders that don't respond to traditional treatments (pills, therapy, etc.). When a person tries several different antidepressants and the symptoms persist, doctors call it treatment-resistant depression. And TMS can solve exactly this problem.

In addition, this procedure is recommended for patients who do not tolerate the side effects of antidepressants well.

Results depend on many individual factors, so it's impossible to promise the same effect for every patient. According to clinical studies, approximately 50–60% of patients with treatment-resistant depression achieve clinically significant improvement after a full course of TMS. And 30–40% can achieve symptom remission. In real-world clinical practice, the rates are even higher in some patient groups.

But these are statistics, numbers, and as we know, each case is unique and there is no universal treatment. Before beginning a course of transcranial magnetic stimulation, Dr. Igor Kirzhner conducts a detailed assessment of each patient's health, treatment history, and possible contraindications. Based on this information, he decides whether TMS is suitable for the individual.

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If I decide to try TMS, will I have to give up antidepressants and psychotherapy?

During the course, patients typically continue to take their doctor-prescribed medications, including antidepressants. If the patient's condition improves after TMS, they can discuss changing their treatment with their doctor. Of course, stopping antidepressants on your own is not recommended.

TMS also combines well with psychotherapy. For many patients, a combination of several approaches proves the most effective strategy.

When will I feel better?

This is perhaps the most popular question. The answer, unfortunately, is different from what many people want to hear: TMS doesn't provide instant relief, like "get it done and it's all gone tomorrow."

Changes occur gradually. Some patients experience initial improvements after approximately 10–15 sessions. Sleep typically improves first, energy increases, and concentration improves. Mood changes may occur a little later—after approximately 20–25 sessions.

But every person is different. Some patients respond more quickly, while others only see noticeable improvement toward the end of the course. Therefore, it's not advisable to evaluate the results after the first couple of treatments.

What do people typically notice after a TMS course?

Improvements are not only seen through mood, many patients report that:

• finally start to sleep normally;
• it becomes easier to get out of bed in the morning;
• energy appears;
• interest in familiar activities returns;
• it becomes easier to communicate with loved ones;
• the feeling of internal heaviness decreases;
• concentration improves;
• the level of anxiety decreases;
• plans for the future and the desire to do something appear again.

The first sign of improvement may be a simple desire to leave the house, cook dinner, call a friend, or do something you used to enjoy but no longer do.

How long do the results last?

In patients who respond well to TMS, improvement may be maintained for 6–12 months or longer.

The need for maintenance treatments varies from person to person. Some patients don't require them at all. For others, the doctor may suggest periodic "booster" sessions—for example, several treatments at regular intervals or a repeat course at the first sign of a return of symptoms.

How safe is TMS?

TMS is a well-studied and well-tolerated treatment for depression. Mild pain or discomfort in the head may occasionally occur after the procedure. These sensations usually resolve on their own.

In rare cases, seizures are possible, especially if the patient has a history of seizures or serious neurological conditions. Therefore, before beginning treatment, the doctor carefully reviews the patient's medical history. Particular attention is paid to the presence of metal and electronic implants, particularly in the head, since the TMS procedure relies on a magnetic field.

Can TMS be used for other conditions?

Depression isn't the only area where magnetic brain stimulation is actively used. Researchers are studying various TMS protocols for anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and nicotine addiction.

TMS is also used and studied in neurology—for example, for migraines and certain types of headaches, sleep problems, and certain cognitive disorders.

Whether TMS is suitable for a particular patient and for what purpose it can be used is decided by the doctor.

Can TMS be performed on elderly patients and children?

Yes, age itself is not a barrier. However, before administering TMS to elderly patients, the doctor will consider age-related brain changes, overall health, and other individual factors.

For adolescents, treatment options depend on age, equipment, and indications: some TMS devices are FDA-cleared for the treatment of depression in patients aged 15 and older.

Is TMS covered by insurance?

In many cases, yes. Major insurance companies, including Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealthcare, as well as Medicare, cover TMS for treatment-resistant depression if the patient meets the established criteria.

Insurance companies typically require proof that previous treatments have been ineffective. Specific requirements vary depending on the plan.

For patients without insurance coverage or self-paying, the cost of a full course in the US can range from $6,000 to $12,000, depending on the protocol chosen.

If you or your loved ones are interested in the TMS procedure, sign up for a consultation to the clinic of Dr. Igor Kirzhner:

• 929-617-8635
• Avant-Garde Psychiatric Consulting, 56 Brighton 11th Street, Suite 2A, Brooklyn, NY 11235

Reception is conducted in Russian and English.