What Are the Alternatives to Antidepressants?

Written by Neuro Wellness TMS Centers of AmericaMedically reviewed by Daniel Pietras, MDPublished November 3, 2026Last medically reviewed November 3, 2026Last updated November 3, 2026

Alternatives to antidepressant medication include TMS, SAINT® accelerated TMS, SPRAVATO® (esketamine), psychotherapy, and lifestyle approaches. TMS and SAINT® use magnetic brain stimulation and introduce no chemical into the body. SPRAVATO® is an in-office nasal spray that works through a different mechanism than oral antidepressants. Psychotherapy (CBT, behavioral activation, interpersonal therapy) is an evidence-based non-medication option. For severe or treatment-resistant depression, these alternatives may be appropriate. The best choice depends on your clinical circumstances and should be discussed with a psychiatrist.

Key takeaways

TMS and SAINT® are non-medication brain stimulation alternatives.
SPRAVATO® works through a different mechanism than oral antidepressants.
Psychotherapy is an evidence-based non-medication option.
These alternatives are FDA-cleared or approved for depression.
The best choice depends on clinical circumstances.

TMS (Transcranial Magnetic Stimulation)

TMS is FDA-cleared for adults with major depressive disorder who haven't improved on antidepressant medication. It uses magnetic pulses to stimulate the left dorsolateral prefrontal cortex — a brain region involved in mood regulation. TMS introduces no chemical into the body and doesn't cause systemic side effects like weight gain or sexual dysfunction. A standard course is about 36 sessions over six weeks. TMS is broadly covered by insurance for treatment-resistant depression.

SAINT® Accelerated TMS

SAINT® is an accelerated TMS protocol — 50 sessions in five days with fMRI-guided targeting. Like TMS, it is non-invasive and introduces no chemical. SAINT® uses a personalized target chosen from each patient's own brain scan. In a sham-controlled trial, 79% of the active group reached remission. SAINT® may be appropriate for treatment-resistant depression when a faster timeline is desired.

SPRAVATO® (Esketamine)

SPRAVATO® is an FDA-approved nasal spray for treatment-resistant depression. It works through NMDA receptor modulation — a different mechanism than standard antidepressants (which target serotonin, norepinephrine, or dopamine). SPRAVATO® is administered in-office under monitoring and requires a driver home. It may be an alternative for patients who haven't responded to oral antidepressants.

Psychotherapy

Psychotherapy is an evidence-based non-medication treatment for depression. Types include cognitive behavioral therapy (CBT), behavioral activation, interpersonal therapy, and mindfulness-based approaches. For mild-to-moderate depression, therapy can be as effective as medication. For moderate-to-severe depression, combining therapy with medication or other treatments is often more effective. Therapy is frequently part of a TMS or SAINT® treatment plan.

Lifestyle Approaches

Lifestyle approaches — regular exercise, consistent sleep, daylight exposure, reduced alcohol, and social connection — have evidence for mild depressive symptoms. These are helpful additions but are rarely sufficient as stand-alone treatments for moderate-to-severe depression. They work best as part of a comprehensive treatment plan that may include therapy, medication, or brain stimulation treatments.

Is it really SAINT®? 5 checks

Before you pay for any 5-day program advertised as SAINT®, confirm these five points.

1
Is the clinic listed on Magnus Medical's provider locator?
If a clinic isn't on the official Magnus Medical locator (magnusmedical.com), it is not a verified SAINT® provider. Magnus Medical locator
2
Do they do a brain MRI to personalize your target?
SAINT® requires a brain MRI to find your individual target. No scan = not SAINT®.
3
Which TMS machine and software do they use?
SAINT® runs only on the Magnus Medical system with its FDA-cleared targeting software.
4
Is the 5-day protocol FDA-cleared, or off-label?
Ask the clinic to state in writing whether their 5-day protocol is FDA-cleared or an off-label schedule.
5
Do they offer it to minors?
SAINT® is FDA-cleared for adults only. Be cautious if a clinic offers an accelerated course to a teen or child.

Watch & Learn

Understanding SAINT® TMS: How It Works & What to Expect

SAINT® is an FDA-cleared treatment for adults with major depressive disorder who have not improved on antidepressants in the current episode. These videos explain how it works and how it differs from conventional TMS.

SAINT® is an FDA-cleared, fMRI-guided form of TMS developed at Stanford. Most patients complete treatment in one week — not the six weeks standard TMS requires.

Follow a real patient through the five-day SAINT® treatment week

Is SAINT® TMS Right for You?

Tried antidepressants without enough relief? SAINT® TMS is an FDA-cleared, fMRI-guided treatment for adults with major depressive disorder who have not improved enough with antidepressant medication.

SAINT® uses a personalized brain target and delivers treatment over five consecutive days. It differs from standard TMS in its targeting approach, treatment schedule, and research background. In a small randomized trial, 11 of 14 people receiving active treatment reached remission at the four-week assessment, compared with 2 of 15 receiving sham treatment. Results vary, and a five-day treatment course does not guarantee remission in five days.

How SAINT® Works and How It Differs From Conventional TMS

SAINT® is an FDA-cleared treatment for adults with major depressive disorder who have not improved on antidepressants in the current episode. This video explains how it works, and how it differs from conventional TMS.

Conventional TMS usually means about 30 visits over 6 to 9 weeks. SAINT is five visits over five days.

What makes it different: SAINT is the only FDA-cleared depression treatment that uses an fMRI scan to personalize the stimulation target to your individual brain. A 45-minute scan maps your brain and identifies the specific circuit linked to depression. Treatment is then delivered as ten 10-minute sessions per day, with 50-minute breaks between them, across five consecutive days.

In clinical trials, 79% of participants reached remission, with an average of 2.6 days to remission. SAINT is generally well tolerated; the most common side effects reported were mild headache and temporary scalp discomfort at the treatment site.

SAINT® at Neuro Wellness TMS Centers of America

Coral Springs, Florida
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Call or Text: 954-827-9793

Sources: Cole et al., American Journal of Psychiatry 2020;177:716-726 and 2022;179(2):132-141. magnusmedical.com/depression-therapy. PubMed 34711062. FDA 510(k) K220177.

Insurance coverage for SAINT is currently limited and varies by plan. Individual results may vary. This video is educational and is not medical advice. Talk to a qualified clinician about whether SAINT is appropriate for you. If you are in crisis, call or text 988.