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By Dr. David Woo - May 8, 2023
If you’re researching TMS, you may occasionally see discussions online where people write about how TMS made them worse, or report that “TMS ruined my life.” TMS has a high success rate in treating people with depression who do not find relief with antidepressants with little to no side effects, but it’s true that TMS will not work for everyone and that some people may have a negative experience with it.
But negative experiences with TMS are rare, and it’s important to remember that the fact that someone else had a negative experience doesn’t mean that your experience with TMS will be negative. I’d like to address why someone might have negative feelings toward TMS, and why you shouldn’t worry when it comes to considering treatment with TMS.
Some People Experience a “Dip” During TMS Treatment
Most patients go through TMS treatment with little to no side effects. However, there are some patients who experience a TMS “dip” about halfway through treatment. During a dip, a patient may experience a temporary worsening of depression or anxiety symptoms. In our clinic, roughly 20% of our patients experience a temporary dip around week two or three of treatment.
The TMS dip could be the result of the changes that occur in the brain after TMS. TMS uses magnetic pulses to electrically stimulate underactive neurons (brain cells). When underactive neurons are stimulated, they begin to release more neurotransmitters than before (chemical messengers in the brain). This can affect the way that neurons connect and communicate with each other, essentially causing a “reset.” Learn more about what happens in the brain after TMS, here. Patients generally begin to feel better from the TMS dip after the initial three to four weeks of treatment.
TMS isn’t the only depression treatment that can cause a dip. For example, patients taking antidepressants may also feel a dip at the beginning of treatment. At first, patients may notice a worsening of their symptoms and may experience unpleasant side effects before feeling better. Antidepressants take time to work and for patients to get the full benefits. For this reason, doctors encourage patients to stick with an antidepressant for 6 to 8 weeks before deciding if it’s not working.
If you’re experiencing a dip in your symptoms while being treated for depression, talk to your doctor. It’s important to continue treatment, even if you experience a dip. Your doctor can help you manage symptoms during a dip.
Some People May Require a Second Round of TMS or TMS + Another Treatment
Everyone responds to different depression treatments differently. Depression treatment often involves a long-term plan that involves trying different treatments and finding what works best for that person. People with difficult-to-treat depression who do not respond to antidepressants are the most difficult patients to treat. Some patients may require a second round of TMS, maintenance sessions, or TMS combined with another treatment option, like an antidepressant.
Some People May Need to Confirm Their Diagnosis
While it’s not common, it’s possible for someone who has bipolar disorder to be diagnosed with depression. TMS is not an approved treatment option for bipolar disorder and may make bipolar symptoms worse.(1) If you’ve ever experienced symptoms of mania or hypomania, or if you have a family member who has experienced these symptoms or who has been diagnosed with bipolar disorder, it would be advisable that you get a second opinion.
TMS is Proven to Be Safe and Effective in Treating Depression
Studies show by and large that TMS is extremely safe and highly effective when used correctly and when the patient is diagnosed correctly with a disorder that TMS is known to treat, like depression.(2)
Additionally, patients meet regularly with their psychiatrist during and after TMS treatment. During this time, your doctor will ask how you are handling treatment and will make adjustments if needed.
While some people may have a negative experience with TMS and may say that “TMS ruined my life,” we don’t recommend that a patient make their decisions based on what happened to a few people. Based on the results from numerous real-world clinical studies, chances are that TMS will work for you.
1. Hett D and Marwaha S. Repetitive transcranial magnetic stimulation in the treatment of bipolar disorder. Sage. Ther Adv Psychopharmacol. 2020 Nov 18;10:2045125320973790. https://pubmed.ncbi.nlm.nih.gov/33282175/. October 06, 2021.
2. Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety. 2012 Jul;29(7):587-96. https://pubmed.ncbi.nlm.nih.gov/22689344/. Accessed October 06, 2021.
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