Lived experiences, adherence, and transformation in patients with treatment-resistant depression undergoing transcranial magnetic stimulation (TMS): An interpretative phenomenological study

Treatment-resistant depression (TRD) poses a critical challenge, particularly where conventional treatments fail. Transcranial magnetic stimulation (TMS) has shown clinical efficacy, yet little is known about how patients in Peruvian contexts perceive this intervention. This study explored patients' lived experiences of TMS, emphasising how adherence, acceptance, and perceived efficacy were shaped by subjective, relational, and contextual factors. Using Interpretative Phenomenological Analysis (IPA), five women aged 21-38 with TRD completed a 30-session protocol at a specialised mental health centre in Arequipa, Peru. Data were collected through semi-structured interviews, clinical logbooks, and clinical observations, and analysed following SRQR standards. Four experiential themes emerged: perceptions of TMS, factors influencing adherence, emotional evolution, and reflections shaping the therapeutic experience. Findings reveal that adherence was sustained not only by expectations of efficacy but also by therapeutic alliance, emotional validation, and embodied safety. TMS was re-signified as an integrative experience involving relational, emotional, and existential dimensions.