I've heard about a genetic test that can tell what psychiatric drugs will work best for someone. Is that something you could look into? In the meantime, you could try seeing this p-doc, but emphasize you're not interested in TMS at this time. I understand there could be pressure to do it--a company that does that recently opened an office in our area, and they've been wooing the T's at my T's practice. Like, taking them out to a fancy dinner, giving presentations, etc. So my T was kinda pushing it for a bit there. But then she eventually asked my p-doc about it, who said I have both depression and anxiety, and TMS hasn't really been studied for anxiety, so she didn't recommend it until more studies have been done (since it could theoretically have a negative effect on me).

As for other approaches, since so many meds haven't worked for you--have you ever seen a holistic/integrative doctor? I just started seeing one, and she did a much more thorough history than any other MD has done on me (like pages of questionnaires, a 90-minute initial consulation) and ordered various blood tests--some more standard ones, like CBC, thyroid, metabolic panel, vitamin D, but also for candida, food intolerance, chronic infection etc.--plus a genetic test because she wants to check for possible methylation issues (could be I'm not metabolizing B12 correctly, for example, which could explain my persistent fatigue). But that would be something to consider. Or even if you haven't checked in with a primary care doctor, just to get things like thyroid, anemia, etc. checked. Because all those things can affect your health, including mental health.

So, hope some of that helps!