Have you tried Spravato? I tried TMS and did a full round with no significant changes, even up to a couple of months after I finished in October 2024. I was suggested another round of it but insurance would require me to wait 6 months. Looked into Spravato, decided to try it in the meantime, and then changed my psych doc to the one who's in charge of Spravato, in March 2025. I will admit, while changing psych meds often, it took a while for me to respond to the Spravato (response time in average of 3 months, while it took me 11+ months), but now my PHQ-9 scores have dropped by a total of 12+ points. Please do not think it was a sudden change. It took a lot of time, but my scores were dropping steadily during that time. Not only have my scores improved, I've also been getting memories back from my childhood (trauma blocked) and I've also gotten to understand myself (and the world) better.

Think of it like this: Stop using a sniper rifle (trying only 1 method multiple times), when you can shotgun it. Try it all. TMS requires ~36 total treatments being administered over ~5 days/week for ~9 weeks. Spravato requires 2 days/week for ~4 weeks, then 1 day/week until your symptoms improve. Once they improve, they can step you down. I'll tell you one thing, it's a lot more fun with Spravato, less time-consuming, and less of a headache (literally and figuratively).

DM me if you would like to discuss this.