By Dr. David Woo - July 2, 2021
Before starting TMS treatment, many patients worry not only about the possibility that TMS will be ineffective for them, but that it could make them worse. When used correctly, and when the patient is diagnosed correctly with a disorder that TMS is known to treat, such as depression, anxiety, OCD, and PTSD, then TMS should not make a patient worse.(1,2,3,4,5)
How Does TMS Work?
TMS (transcranial magnetic stimulation) electrically stimulates nerve cells in a specific region of the brain called the dorsolateral prefrontal cortex (DLPFC). When nerve cells in this part of the brain are stimulated, they start to form new connections with nerve cells in other regions of the brain, essentially forming new communication pathways and alleviating symptoms of depression.(6,7)
During a TMS treatment session, magnetic pulses are delivered to the scalp via a magnetic coil that is carefully placed above the head. These magnetic pulses stimulate underactive brain cells and disrupt the brain’s normal patterns of communication (the patterns associated with depression, OCD, and PTSD).(6,7)
Some Patients May Experience a “Dip” in the Middle of Treatment
Most patients experience zero to mild side effects during TMS treatment, but some people may experience what’s called a “TMS dip.” A TMS dip is a temporary worsening of symptoms that occurs about halfway through treatment. Although this “dip” can feel frustrating, it is only temporary, and with time patients should start to feel relief from their symptoms. Learn more about the TMS dip and why it happens here.
When Can TMS Make Symptoms Worse for Patients?
While TMS does not worsen symptoms for patients who are correctly diagnosed with a condition that TMS is known to treat (such as depression, anxiety, OCD, and PTSD), TMS may possibly worsen symptoms for patients with conditions that TMS are not know to treat, such as schizophrenia or bipolar disorder.
A review of the clinical studies that observed the effects of TMS on patients diagnosed with schizophrenia shows that TMS does not significantly improve symptoms. There is some evidence that TMS may help slightly improve the negative symptoms of schizophrenia, like difficulty speaking and flattening (showing no emotion). However, one study showed that TMS actually worsened the positive symptoms of schizophrenia, including delusions and hallucinations, in patients.(8)
More research is needed to fully understand the effects of TMS on patients diagnosed with bipolar disorder. So far, studies are inconclusive as to whether TMS triggers mania in patients diagnosed with bipolar disorder. Some studies have shown that TMS does not significantly increase mania symptoms in people with bipolar disorder, while others have shown that it does. (9)
Still Have Questions?
1. 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 June 22, 2021.
2. Paulesu E, Sambugaro E, Torti T, Danelli L, Ferri F, Scialfa G, Sberna M, Ruggiero GM, Bottini G, Sassaroli S. Neural correlates of worry in generalized anxiety disorder and in normal controls: a functional MRI study. Psychological Medicine. 2010;40(1):117-124. https://pubmed.ncbi.nlm.nih.gov/19419593/. Accessed June 22, 2021.
3. US Food & Drug Administration. FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. Published August 17, 2018. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder. Accessed June 22, 2021.
4. Carmi L, Tendler A, Bystritsky A, etal. Efficacy and Safety of Deep Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder: A Prospective Multicenter Randomized Double-Blind Placebo-Controlled Trial. Am J Psychiatry. 2019;176(11):931-938. https://pubmed.ncbi.nlm.nih.gov/31109199/. Accessed June 22, 2021.
5. Namgung E, Kim M, and Yoon S. Repetitive transcranial magnetic stimulation in trauma-related conditions. Neuropsychiatric Disease and Treatment. 2019;15:701–712. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430993/. Accessed June 22, 2021.
6. Neurostar mechanism of action. YouTube: Neurostar Advanced Therapy. https://www.youtube.com/watch?v=qeFZikBZCHU&t=0s. Published on June 07, 2021. Accessed June 22, 2021.
7. Kozyrev V, Staadt R, Eysel UT, and Jancke D. TMS-induced neuronal plasticity enables targeted remodeling of visual cortical maps. PNAS. 2018;115(25):6476-6481. https://www.pnas.org/content/115/25/6476. Accessed June 22, 2021.
8. Marzouk T, Winkelbeiner S, Azizi H, et al. Transcranial Magnetic Stimulation for Positive Symptoms in Schizophrenia: A Systematic Review. Neuropsychobiology. 2020;79:384–396. https://www.karger.com/Article/FullText/502148. Accessed June 22, 2021.
9. 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/. Accessed June 22, 2021.