February 13, 2025 - Smart TMS
When you first start to research Transcranial Magnetic Stimulation (TMS), it’s possible that you might find articles in Google claiming that TMS can make your depression worse. Reading claims such as this are bound to worry you, but it’s important to understand the bigger context, and how TMS treatment for depression has had an incredibly positive impact for so many patients.
TMS can be very effective in treating depression especially when other treatments such as antidepressants have not worked, and typically TMS has very few or no side effects at all. Negative experiences with TMS are very uncommon, so it’s crucial to understand that just because someone else has commented on having a negative experience, it is important to do your research and know that this is not the case for most people.
What is TMS?
Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation treatment used primarily for treatment-resistant mental health conditions. It works by using magnetic fields to stimulate nerve cells in the brain. During a TMS therapy session, an electromagnetic coil is placed against the scalp on the necessary treatment point. The coil generates magnetic pulses that pass through the skull and induce electrical currents in specific regions of the brain, particularly those involved in mood regulation.
The mechanisms behind TMS involve modulating neuronal activity. The magnetic pulses can either increase or decrease brain activity in targeted areas. For example, in treating depression, TMS typically targets the left prefrontal cortex, a region that often shows reduced activity in individuals with depression. By stimulating this area, it can enhance neuronal activity and connectivity, meaning TMS can help to lift mood and reduce symptoms of depression.
TMS is considered safe and is generally well-tolerated, with the most common side effects being mild scalp discomfort and mild headaches during treatment. It offers a promising alternative for individuals who have not responded to traditional antidepressant medications and/or talk therapies.
Can TMS make your depression worse?
Research has indicated that whilst TMS is safe and effective for treating depression, it can occasionally lead to an increase in anxiety symptoms. For instance, studies have documented cases where repetitive TMS (rTMS) caused heightened anxiety in individuals with an existing panic disorder (Diefenbach et al., 2016). However, these instances are not very common and tend to be a temporary increase during treatment and will reduce as treatment progresses.
In the majority of cases, clinical studies show that TMS does not make depression or anxiety symptoms worse and is well tolerated by most people who undergo treatment (Cohen et al., 2010; George et al., 2010) and there is no substantial evidence suggesting symptoms will be heightened. The temporary worsening of symptoms, often referred to as the “TMS dip,” (which we explain below) can occur midway through the treatment but typically subsides as treatment continues (O’Reardon et al., 2007; George et al., 2010).
The “TMS” Dip
We mentioned the “TMS dip” in the last section. This is where approximately one in five patients experience a “TMS dip” around the second or third week of treatment, characterised by a temporary worsening of depression or anxiety symptoms (Daskalakis et al., 2002; Shah et al., 2015).
This dip may be due to the brain’s adjustments to the changes induced by TMS. The magnetic pulses stimulate underactive neurons, increasing neurotransmitter release and altering neuronal connections, essentially causing a “reset” in brain communication pathways (Pollak et al., 2014).
It’s important to recognise that this only accounts for a small percentage of patients, as the majority of people who have TMS treatment for depression have minimal to no side effects.
For the patients who do suffer a dip, they generally feel an improvement three to four weeks afterwards (Daskalakis et al., 2002). Similar to TMS, other depression treatments like antidepressants can also cause an initial dip. Patients often experience a temporary worsening of symptoms and side effects before seeing improvements, which is why doctors recommend continuing antidepressants for 6 to 8 weeks to fully assess their effectiveness (Peterson et al., 2018).
Conclusion
Whilst there may be cases where TMS can be said to worsen depression, this will mainly be attributed to the TMS dip as described above.
Extensive research has shown that TMS is a safe and highly effective treatment for a range of mental health conditions, including depression, anxiety disorders, OCD, and PTSD (Daskalakis et al., 2002; Shah et al., 2015; George et al., 2000).
During TMS treatment, patients have regular check-ins with their clinician to monitor progress and make necessary adjustments, ensuring the best outcomes.
While a few individuals may report negative experiences with TMS, these instances are rare. It’s important to base your decision on the broad evidence from numerous clinical studies, which overwhelmingly indicate that TMS is likely to benefit most patients. By choosing TMS, you are opting for a treatment backed by solid scientific research and proven success.
