What is a TMS Dip and How Long Does It Last?

Millions of people throughout the world experience depression on a daily basis. From the inability to get out of bed in the morning to overeating throughout the day to cancelling plans with others, depression often significantly interferes in a person’s life. So when the possibility presents itself to gain some relief from the symptoms that cause these behaviors, those with depression have something to look forward to.

Traditionally, depression and other mood disorders are treated with a combination of medication and therapy. The vast majority of people who have depression are treated in this manner and benefit from its effectiveness. While depression is not curable, this type of treatment can help combat the weight that depression produces. Unfortunately for some, medication and therapy does not do the trick. They may spend a great deal of time working with their mental health professional to find the right medication for them to no avail. They may even increase the amount of therapy sessions they participate in but still see minimal effects. Those who experience this are known to have treatment-resistant depression, or TRD. TRD occurs in about 10-30% of people with depression and often requires non-traditional forms of therapy to treat. One of those forms of therapy is transcranial magnetic stimulation, or TMS.

TMS therapy is a newer form of FDA approved depression treatment that involves the use of a magnetic coil to help relieve symptoms. A medical professional will place a metal coil on the forehead of the patient (or other targeted area of the head) and deliver magnetic waves to certain areas of the brain. Usually, when treating treatment-resistant depression, these waves are sent to areas of the prefrontal cortex, which are responsible for emotional regulation. Over a series of several sessions, patients will see a significant reduction in their symptoms. The greatest benefit of TMS is that despite how it sounds on paper, it is a painless, non-invasive procedure with nearly no health risks associated with it.

So, exactly how does TMS work? The magnetic waves that are sent to the brain work to help create new pathways for neurons. Part of the issue for those with depression is that neurons in their brains are usually underactive or completely inactive. Therefore, the magnetic waves stimulate those neurons, leading to a release of neurotransmitters that help rewire the brain for the better. Most individuals see differences right away; however, there are some people who experience a TMS dip. This dip can be discouraging for people undergoing treatment, but it is normal. Fortunately, it is temporary.

In some cases, those who are receiving TMS therapy may notice that their symptoms begin to worsen around the second or third session. This can be extremely discouraging and upsetting for the patient. This is known as a TMS dip, and it occurs in nearly one-quarter of all TMS patients. 

TMS therapy is designed to help recreate pathways in the brain so that symptoms such as lethargy, sadness, and hopelessness can be remedied. During this time, the brain is experiencing a number of big changes because the magnetic waves from the TMS coil are stimulating certain areas. While this is the goal of TMS therapy, it does not mean that all success happens overnight. 

A TMS dip occurs because the brain is essentially rewiring itself. This is a process that can take time and can result in experiencing temporary unsatisfactory results. However, it is important to understand that a TMS dip is normal and occurs in some patients. This does not mean that TMS is not working or that the patient’s depression is untreatable, it just means that more time and therapy sessions are required to help the brain continue to rewire itself effectively. 

Similar to what happens with antidepressants, patients undergoing TMS therapy can experience a temporary decline in their treatment progress. It’s normal for patients to see an improvement in their symptoms early, so when this dip occurs, you may begin to question what is happening.

A TMS dip occurs because the brain is essentially rewiring itself. TMS therapy targets the prefrontal cortex of the brain and stimulates the neurons, which causes a disruption in how the brain is used to functioning. As the brain is trying to adjust to these new changes and create new pathways, you might experience a disruption or “dip” in your treatment progress.

Moving past this decline is a process that can take time and can result in experiencing temporary unsatisfactory results. However, it is important to understand that a TMS dip is normal and occurs in some patients. This does not mean that TMS is not working or that the patient’s depression is untreatable — it just means that more time and therapy sessions are required to help the brain continue to rewire itself effectively.

If you are experiencing a TMS dip, be sure to let your team of medical professionals know. During this time, your doctor can make adjustments to your treatment plan as well as share advice on how to manage your symptoms.

It’s important to continue treatment even if you do experience a dip. Once you reach the fourth and fifth weeks of your TMS therapy, you can expect to start seeing an improvement in your mood. When your mood begins to stabilize, your doctor will begin tapering your sessions.

Patients who have exhausted standard depression therapies like antidepressants or psychotherapy are ideal candidates for TMS therapy. For patients dealing with treatment-resistant depression or other types of mood disorders, TMS can help you experience an improvement in your symptoms.

This revolutionary treatment is safe and effective for candidates who are still struggling with depression in the current episode. For many patients, antidepressant medications cause symptoms that are difficult to manage and deal with on a daily basis. Patients having difficulty with these symptoms would qualify for TMS therapy.

Keep in mind some individuals aren’t candidates for this type of procedure because it uses a magnetic device. People who have metal or medical devices in their body need to let their doctor know before beginning treatment. These include:

• Aneurysm clips or coils
• Cochlear implants
• Electrodes used to monitor brain activity
• Deep brain stimulator
• Facial tattoos that have either metallic or magnetic-sensitive ink
• Metal stents, especially in the brain or neck
• Metallic implants in the eyes
• Shrapnel or bullet fragments

Also, because this treatment does slightly increase your risk for seizures, patients who have neurological conditions like epilepsy, Parkinson’s disease, dementia, brain tumors or the potential for strokes should let their doctor know before beginning TMS therapy.

With standard treatments like medication, individuals with major depressive disorder often experience a range of side effects. As antidepressants enter the bloodstream, they expose every organ to the medication’s effects. This exposure can result in symptoms like insomnia, anxiety, diarrhea and sexual dysfunction.

As a noninvasive and non-systemic solution, TMS therapy has less disruptive side effects. Because the magnetic coil is placed on your head, you might experience some discomfort on your scalp as the device stimulates your brain.

Along with feeling some gentle tapping while the device is delivering magnetic pulses, it’s common to have a mild headache from the sound and pressure. Some patients also experience facial or jaw tingling, twitching or discomfort during treatment.

It’s more common to experience these side effects during the first couple of weeks after beginning therapy. To help mitigate the potential for discomfort, your doctor will increase the amount of stimulation gradually over time. If the side effects are difficult to manage, the stimulation dose can be lowered.

While it’s extremely rare, TMS therapy can increase the chances of mania in patients with bipolar disorder or cause a seizure in patients who have either an underlying neurological or substance use disorder.

Patients who are experiencing a TMS dip should continue on with their scheduled treatments, as doing so will help reduce the symptoms of their dip and improve their treatment outcomes. During the time of the actual TMS dip, patients are encouraged to reach out to their mental health providers for additional support to see them through the worsening of their symptoms. Thankfully, this dip does not last the duration of the treatment process, as symptoms will begin to improve with more treatment. But, to help cope with TMS dip itself, reaching out for additional psychological support is very helpful.

Attempting to live with untreated or treatment-resistant depression is extremely painful, both physically and mentally. Depression can easily make someone feel completely unwilling to reach out for help despite knowing that they need to. At My TMS, we understand the challenges that accompany depression and associated mood disorders. That is why we work to provide as many treatment options for this particular mental health condition as possible.

My TMS by My Psychiatrist is proud to offer top psychiatric care at four Florida locations; My TMS Oakland Park, My TMS Hollywood, My TMS South Miami, and My TMS Boca Raton. Not only do we provide TMS Therapy, but we offer premier mental health services at My Psychiatrist such as outpatient, substance abuse, and telemedicine services to our patients.

Our team at My TMS is highly experienced and skilled in the provision of depression treatment, including TMS therapy. Their dedication and attention to detail allows all patients to get the best from their experience with us. If you or someone you love is in need of depression treatment, contact us right now. We can help.