Can TMS Worsen Depression?

Can TMS Worsen Depression?

Author: GIA Miami
Published: May 31, 2022

What is Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation, or TMS, is a non-invasive procedure that uses a magnetic field to stimulate certain areas of the brain. The FDA approved TMS in 2008, recognizing it as a safe and effective treatment for depression symptoms such as those caused by major depressive disorder, or treatment resistant depression. Patients undergo this form of brain stimulation treatment in a TMS clinic, in the form of TMS sessions.

How Does TMS Treatment Work?

TMS makes use of a magnetic coil which delivers magnetic pulses to targeted areas of the brain, namely the left dorsolateral prefrontal cortex, the area which governs mood regulation. The coil creates intense magnetic fields similar to those of a Magnetic Resonance Imaging (MRI) scanner, which turn on and off very rapidly (hence the magnetic pulses). This produces very small electric currents within the brain that activate those nerve cells thought to produce dopamine, norepinephrine and serotonin. People suffering from depression have an imbalance of these neurotransmitters in the brain, which TMS can help correct.

Can TMS Make Depression Worse?

Provided a patient is correctly diagnosed with a condition Transcranial Magnetic Stimulation treatment is recommended for, there is no likelihood that TMS treatment will worsen symptoms of depression. Quite to the contrary, in fact, clinical studies have shown that TMS treatment is effective even where other depression treatments have failed. Major depression and treatment resistant depression have both been shown to respond positively to TMS treatments.

However, many patients may experience a slight worsening of their symptoms of depression after a few sessions, usually about half way through a course of treatment. This is short-lived and temporary, and is known as a TMS dip. To understand why the TMS dip can be one of the effects of TMS, and appear to make symptoms worse, it is useful to remember that TMS brain stimulation affects nerve cells that are either under-active or inactive (if they weren't, a person would be unlikely to display depressive symptoms). Transcranial Magnetic Stimulation activates these nerve cells, causing them to start communicating again. They release neurotransmitters - the chemicals that enable neurons to 'talk to' each other. This newly enabled communication - where before there was little or none - creates new communication pathways. However, the brain is not used to functioning in this new way, and may need a short, and always temporary, period to adjust.

Can TMS Make You Worse?

There is no evidence that Transcranial Magnetic Stimulation can worsen symptoms of any condition the treatment is often prescribed for. However, it is possible that people with conditions TMS is not a treatment for, may experience negative effects. Clinical studies of schizophrenia and bipolar disorder show mixed results. TMS seems to improve some of the negative symptoms of schizophrenia, such as hearing voices. Overall, bipolar disorder seems to remain mostly unresponsive to TSM, though there is debate over whether it might make mania symptoms worse. More research is needed to reach a valid conclusion.

What Are the Side Effects and Risks of TMS Treatments?

Transcranial Magnetic Stimulation is considered safe (and approved as such by the FDA), and is well-tolerated by most patients. There is, however, a small number of relatively common side effects of TMS, namely:

  • headaches
  • discomfort on the scalp at the stimulation site
  • tingling or involuntary twitching of facial muscles
  • feeling lightheaded

More pronounced side effects are very rare, but may include:

  • seizures
  • mania, particularly subjects suffering from bipolar disorder
  • temporary loss of hearing, usually when proper ear protection is not worn during treatment

There are no significant risks from undergoing TMS therapy, unless there are specific contraindications to the treatment, as a result of a person's condition or medical history. If you are considering Transcranial Magnetic Stimulation, you should inform your primary care physician if you:

  • have a pacemaker, medication pump, or any other metal object or device in your body
  • have cochlear implants for hearing
  • have a history of seizures, or brain damage from illness or injury
  • have mental health conditions, such as bipolar disorder, psychosis, or substance use disorders.

Can TMS Damage Your Brain?

TMS is entirely non-invasive. Therefore it does not require any form of surgery or the implantation of electrodes. There is no evidence that TMS treatments damage the brain in any way, as long as a person has been confirmed a suitable candidate for TMS by their primary care physician, TMS provider, or other qualified doctor. However, in addition to the contraindications above, parameters which could put a person's brain at risk are the presence of:

  • aneurysm clips or coils
  • implanted stimulators
  • electrodes for monitoring brain activity
  • implants for deep brain stimulation.

TMS Therapy Success Rate in Depression Treatment

By creating new communication pathways in the brain, TMS induces actual physiological changes in the patient, which help improve symptoms of depression. As mentioned above, TMS is often recommended after patients have failed to find symptom relief using antidepressant medications. Even major depressive disorder and treatment resistant depression have been shown to improve thanks to TMS treatment sessions - data shows that approximately 50 to 60% of people who have tried CBT, psychotherapy and medication without success, experience a clinically significant response with TMS. And about a third of these people experience a full remission, that is, their depressive symptoms disappear entirely.

Because Transcranial Magnetic Stimulation targets the prefrontal cortex - the part of the brain linked to mood disorders like depression and anxiety - it is, in a sense, going to the source of the problem. And this appears to give lasting results: most patients feel better for several months after completing treatment, and many for up to a year. And new technology has enabled machines to deliver intermittent theta burst stimulation - a frequency the brain seems more responsive to 3-minute bursts appear to be equal in efficacy to much longer sessions formerly administered.

Other Conditions TMS is Used to Treat

TMS is currently used to address a wider range of recognized mental health conditions, such as Obsessive compulsive disorder (OCD), anxiety, Dual Diagnosis, PTSD and addictions. Because TMS is able to activate specific areas of the brain, it has become clear that its range of action goes well beyond depression, and that it can be a powerful therapy for patients struggling with their mental wellness. More research should reveal quite how far-reaching the potential of TMS is.

What does TMS Therapy feel like?

The physical sensations experienced by patients during a treatment session are like moderate tapping or knocking on the skull, caused by the magnetic pulses generated by the TMS machine. While few patients would describe TMS as actually pleasant, it is not uncommon for people to doze off during treatment, and even those who enjoy it least would most likely describe it as unpleasant rather than actually painful.

Is TMS Therapy Safe?

TMS therapy is entirely safe for the majority of people. If none of the contraindications or conditions mentioned above are present, there is no reason for anyone to experience any adverse effects from TMS.

Transcranial Magnetic Stimulation is a pioneering approach to treating depression and a range of other mental health conditions. At GIA Miami, we believe that our work as a leading TMS clinic would be incomplete without the compassionate, personalized care of our expert therapists, all working to support our patients. To this end, we tailor our holistic method to each individual, because, let's face it, when mental wellness is shaky, all aspects of our lives suffer. But when our mental health is vibrant, even life's challenges seem more manageable. We are here to help - don't hesitate to reach out!

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