How Does Neuromodulation Fit Alongside a Client’s Existing Therapy and Medication?

Direct Answer

It is added rather than substituted. In ordinary practice a client continues their medication and their psychotherapy through a course of neuromodulation, and for clients aged 15 to 21 the relevant FDA clearances are adjunct clearances, meaning concurrent treatment is part of the cleared use rather than an option. The manufacturer’s own guidance is that patients do not need to stop medication or therapy to receive Deep TMS.

Two practical principles follow. Hold the other variables steady during the acute course where clinically safe, because changing medication mid-course makes it impossible to attribute any improvement afterward. And plan for what happens when the course ends, since durability data show most acute responders maintain benefit over a year while a substantial minority of the wider cohort need retreatment, under a regimen that included continuing antidepressant medication.

Adjunct Is a Regulatory Fact, Not a Preference

For the age group most relevant to emerging adult practice, concurrent treatment is built into the clearance. The FDA cleared the NeuroStar Advanced Therapy System as an adjunct for the treatment of major depressive disorder in adolescent patients aged 15 to 21 in March 2024.¹ BrainsWay announced a comparable label expansion for Deep TMS as adjunct therapy for adolescent patients aged 15 to 21 in November 2025.²

Adjunct means alongside something else. A referring clinician who assumes their role ends at the referral has misread the arrangement for these clients, because the clearance itself presumes ongoing treatment. That is worth saying plainly to a client who has interpreted the referral as a sign that therapy has failed.

Medication Generally Continues, and the Durability Data Assume It

Manufacturer guidance is direct on this point. BrainsWay states that patients do not need to stop medication or psychotherapy during Deep TMS, and that treatment can be delivered in combination with either.³ That is a claim about compatibility rather than about efficacy, and it is the question clients actually ask.

The durability evidence rests on the same assumption. A multisite naturalistic observational study following patients with pharmacoresistant major depressive disorder after acute TMS found that among 120 patients who responded or remitted, 62.5 percent continued to meet response criteria throughout a one-year follow-up. Across the full 257-patient follow-up cohort, responders and non-responders together, 36.2 percent received reintroduction of TMS during that period, averaging 16.2 treatment days. The follow-up was conducted under a pragmatic regimen of continuation antidepressant medication with access to retreatment.⁴

Read that carefully with a client. Most people who respond hold their response for a year. A meaningful minority need another course. And the maintenance picture that produced those numbers included staying on medication, so a client planning to stop everything after a successful course is not planning for the conditions the evidence describes.

Psychotherapy During the Course

There is a mechanistic rationale for continuing therapy rather than pausing it. A large naturalistic study of simultaneous rTMS and psychotherapy in major depressive disorder reported a response rate of 66.3 percent and a remission rate of 56.0 percent among 196 patients, with 60 percent of remitters sustaining remission at six-month follow-up. The authors argued that stimulation and psychotherapy target overlapping networks through different pathways, both inducing change through neuroplasticity, and hypothesized that simultaneous application could produce more robust and prolonged effects than either alone.⁵

Those figures require a caveat that a client will not supply for themselves. That study was naturalistic and uncontrolled, so its rates are not comparable to the sham-controlled trial figures used to support clearances, and the absence of a control group means the combination cannot be said to outperform either component. The defensible statement is that combining them is clinically coherent and widely practiced, not that combination is proven superior.

Hold the Variables Steady

The most useful thing a referring clinician can do during a course is resist changing anything else. If medication is adjusted in week two and the client improves in week four, nobody can say what worked, and the client will be left without a clear answer about what to maintain afterward.

Where a medication change is clinically necessary, it should happen and it should be documented with dates so the treating team can interpret the course afterward. The principle is not that nothing may change. It is that changes should be deliberate, minimal and recorded rather than incidental.

Yellowbrick provides neuroscience technologies and neuromodulation services through an agreement with its sister company Synchrony Brain Health, whose outpatient services include Deep TMS and neurofeedback alongside psychotherapy services, and Yellowbrick’s own approach integrates neuroscience with psychiatric and family treatment. Where prescribing, therapy and neuromodulation sit in different organizations, agreeing in advance who holds the medication decisions during a course prevents the coordination gap that otherwise appears around week three.

What Continues, What Changes and What to Watch

What to Agree Before the Course Begins

• That therapy continues, stated explicitly to the client rather than assumed.
• Who holds medication decisions during the course, and how changes will be communicated.
• That non-essential medication changes will be deferred until the course ends where clinically safe.
• Which symptom measure will be used, and at what intervals, so change is interpretable.
• What would count as a response, defined before treatment rather than judged afterward.
• When during the course a mid-point review will happen.
• What the plan is if there is no response by the end of the course.
• What happens to medication after a successful course, and who decides.
• That retreatment is a normal possibility rather than a sign of failure.
• How the treating service will report back to you, and the release that permits it.

Key Takeaway

Neuromodulation is added to a treatment plan rather than swapped into it. For clients aged 15 to 21 the relevant clearances are adjunct clearances, so concurrent treatment is part of the cleared use. Medication and therapy normally continue, and manufacturer guidance is explicit that neither needs to stop. The durability evidence was generated under continuation medication. Hold other variables steady during the acute course so that any improvement can be attributed, and document any change that is clinically necessary. Plan the ending before the course finishes: most acute responders maintained response over a year, while about a third of the full follow-up cohort was retreated. Frame combination as clinically coherent rather than as proven superior, since the strongest combination data come from uncontrolled naturalistic studies.

Clinical Note

This article is general guidance for referring clinicians. It is not a substitute for individual clinical judgment or an individualized assessment and it does not constitute medical advice. Do not start, stop or adjust any medication on the basis of this article. Medication decisions rest with the prescriber and treatment decisions rest with the treating service. Study results describe populations and do not predict outcomes for any individual. FDA clearances are device-specific and indication-specific and change over time, so confirm current clearance and protocol directly with the service.

If a client is in immediate danger, direct them to emergency services. The 988 Suicide and Crisis Lifeline provides free, confidential crisis support 24 hours a day, seven days a week, by call or text to 988.⁶

Glossary

• Adjunct clearance: an FDA clearance for use alongside another treatment rather than as a standalone therapy.
• Acute course: the initial defined block of treatment sessions, as distinct from maintenance or retreatment.
• Continuation treatment: ongoing treatment after an acute course intended to maintain response.
• Reintroduction or retreatment: a further course of stimulation delivered after symptoms recur.
• Naturalistic study: an observational study of routine practice without randomization or a control group, useful for describing practice and weak for establishing superiority.
• Durability: the extent to which benefit is maintained after the acute course ends.
• Confounding: the situation created when more than one treatment variable changes at once, making the cause of improvement unattributable.

References

1. U.S. Food and Drug Administration. “NeuroStar Advanced Therapy System, 510(k) Premarket Notification K231926.” Neuronetics, Inc., cleared March 22, 2024. Accessed August 25, 2026. https://www.accessdata.fda.gov/cdrh_docs/pdf23/K231926.pdf.
2. BrainsWay. “BrainsWay Receives FDA Clearance of Deep TMS as Adjunct Therapy for Major Depressive Disorder (MDD) in Adolescents Aged 15 to 21.” Company announcement, November 12, 2025. Accessed August 25, 2026. https://www.brainsway.com/news_events/brainsway-receives-fda-clearance-of-deep-tms-as-adjunct-therapy-for-major-depressive-disorder-mdd-in-adolescents-aged-15-to-21/.
3. BrainsWay. “Will I need to stop my medication or therapy?” BrainsWay patient FAQ. Accessed August 25, 2026. https://www.brainsway.com/patients-faqs/will-i-need-to-stop-my-medication-or-therapy/.
4. Janicak PG, Dunner DL, Carpenter LL, et al. “A Multisite, Naturalistic, Observational Study of Transcranial Magnetic Stimulation for Patients With Pharmacoresistant Major Depressive Disorder: Durability of Benefit Over a 1-Year Follow-Up Period.” The Journal of Clinical Psychiatry, 2014. Accessed August 25, 2026. https://www.psychiatrist.com/jcp/multisite-naturalistic-observational-study-transcranial/.
5. Donse L, et al. “Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study.” Brain Stimulation, 2017. Accessed August 25, 2026. https://www.brainstimjrnl.com/article/S1935-861X(17)30960-9/fulltext.
6. 988 Suicide and Crisis Lifeline. Operated in partnership with the Substance Abuse and Mental Health Services Administration and Vibrant Emotional Health. Accessed August 25, 2026. https://988lifeline.org/.

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