TMS Dip: Understanding the Phenomenon and How to Manage It

Clinically Reviewed by Brittany Astrom

Brittany has 15 years of experience in the Mental Health and Substance Abuse field. Brittany has been licensed for almost 8 years and has worked in various settings throughout her career, including inpatient psychiatric treatment, outpatient, residential treatment center, PHP and IOP settings.

Transcranial Magnetic Stimulation (TMS) therapy is a clinically-approved treatment for Major Depression, Obsessive-Compulsive Disorder (OCD), and other mental health conditions. This noninvasive treatment uses an electromagnetic coil to stimulate the prefrontal cortex, an area of the brain responsible for mood regulation. Many patients experience symptom relief, but some encounter a temporary worsening of depression symptoms known as the TMS Dip.

TMS therapy is an effective treatment that uses magnetic waves to target nerve cells in the prefrontal cortex. The treatment protocol consists of daily treatment sessions over several weeks of treatment. This method is often recommended for individuals with treatment-resistant depression, bipolar disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD) who have not responded to standard treatments, such as antidepressant medications or psychotherapy.

A TMS Dip refers to a temporary period of worsening of symptoms, such as increased depressive symptoms, heightened anxiety, or disruptions in sleep patterns, before an eventual improvement.

Understanding the TMS Dip Phenomenon

The TMS Dip occurs because brain stimulation therapies trigger changes in neural pathways and brain activity. As the magnetic coil delivers electrical activity to underactive brain cells, the communication pathways between nerve cells adapt. This adjustment phase can lead to a temporary increase in symptoms before the brain establishes new activity patterns that promote control of symptoms.

Signs and Symptoms of a TMS Dip

Patients may experience:

• Depressive symptoms such as depressed mood and low energy levels
• Heightened anxiety symptoms or anxious depression
• Temporary exacerbation of compulsive disorder symptoms
• Exacerbation of symptoms related to sleep patterns
• Temporary setbacks in their treatment journey

When Does the TMS Dip Occur?

A TMS Dip typically appears within the week of treatment and can last a few days. It is most commonly reported between the 3rd and 4th treatment session but can occur at different stages of treatment based on individual experiences.

How Common Is the TMS Dip Among Patients?

Not all patients experience a TMS Dip, but it is a recognized part of the treatment process. Studies, including those in Psychiatry Research, suggest that while temporary exacerbation of symptoms occurs, most individuals experience symptom relief by the end of their treatment protocol.

Patients can manage worsening of depression symptoms by incorporating Self-Care Practices and maintaining communication with their healthcare provider.

Self-Care Techniques

• Adequate sleep: Ensuring a healthy sleep pattern supports brain recovery.
• Regular exercise: Light movement can improve activity in nerve cells and enhance mood.
• Engaging in wellness practices: Meditation, deep breathing, and journaling can help regulate brain activity.
• Limiting stressors: Reducing emotional triggers can minimize temporary side effects.

Communication with Healthcare Providers

• Report symptoms: If patients experience a temporary worsening of depression, they should inform their mental health provider.
• Discuss medication adjustments: Some individuals may require a combination of medication and TMS therapy for optimal outcomes.
• Stay consistent with treatment: Consistent treatment ensures long-term improvements in brain patterns and communication patterns.

While TMS therapy is a cutting-edge brain stimulation treatment, some individuals may experience common side effects, including:

• Scalp discomfort at the application site
• Temporary side effects such as lightheadedness
• Mild twitching in facial muscles due to activity of nerve cells
• Headaches as a result of increased electrical activity in the brain

These side effects are usually temporary and subside as the brain adapts to the treatment protocol.

Despite temporary setbacks, continuing daily treatment is essential for long-term success. Stopping treatment early due to a TMS Dip may lead to treatment failure or prevent patients from achieving adequate benefit.

Patients with treatment-resistant depression, affective disorder, psychiatric conditions, or those who have experienced depression-related disorders that do not respond to traditional treatments are good candidates for TMS therapy.

• Noninvasive treatment with minimal adverse effects
• No sexual dysfunction, unlike many antidepressant medication increases
• Revolutionary treatment for individuals with treatment failure
• Alternative to electroconvulsive therapy (ECT), which can cause cognitive effects such as memory loss

Treatment

Effectiveness

Side Effects

Invasiveness

TMS Therapy

High for

treatment-resistant depression

Temporary side effects

(e.g.,

scalp discomfort

)

Noninvasive

Antidepressant Medications

Varies per individual

Sexual dysfunction

,

weight gain

Oral medication

Electroconvulsive Therapy

Very high

Cognitive effects

,

memory loss

Invasive

Psychotherapy

Moderate to high

None

Noninvasive

Studies, including a systematic review and meta-analysis, show that TMS therapy leads to remission of symptoms in about 30% of people with depression and significant symptom relief in 50-60% of patients.

A TMS Dip is a transient phase that can cause temporary exacerbation of depressive symptoms. However, this is a normal part of the adjustment period. Patients should focus on Self-Care Practices, stay in touch with their treatment team, and trust the stimulation for depression process. By maintaining consistent treatment, individuals can experience the full benefits of this advised treatment option and achieve lasting improvements in mental health treatment.

1\. What causes a TMS Dip, and why does it happen?

A TMS Dip occurs due to changes in brain activity as magnetic stimulation influences the prefrontal cortex and neural pathways. During the adjustment phase, some patients experience a temporary exacerbation of depressive symptoms, including increased anxiety symptoms, disruptions in sleep patterns, and a feeling that their depression is worse. This is part of the treatment process as the brain adapts to electromagnetic coil stimulation and adjusts its communication pathways.

2\. How long does the TMS Dip last?

The TMS Dip typically occurs within the week of treatment and may last from a few days up to a week. However, this varies based on individual experiences. Most patients report improvement as they continue their treatment sessions, and the temporary period of worsening of symptoms subsides as the treatment for depression progresses.

3\. What can I do to manage TMS Dip symptoms?

Managing a TMS Dip involves Self-Care Practices, such as adequate sleep, regular exercise, and engaging in wellness practices like meditation or deep breathing. Patients should also maintain open communication with their healthcare provider and avoid skipping daily treatment sessions. Sticking to the treatment protocol ensures that the brain continues adapting to the stimulation for depression, reducing the impact of the temporary setbacks.

4\. Should I stop TMS therapy if I experience a TMS Dip?

No, stopping TMS therapy prematurely can lead to treatment failure and prevent patients from achieving remission of symptoms. The temporary side effects associated with the TMS Dip are a normal part of the treatment journey, and most individuals experience symptom relief once they complete their treatment protocol. If symptoms become overwhelming, speaking with a mental health provider can help adjust the approach while ensuring consistent treatment.