Can TMS Make Depression Worse?

Transcranial magnetic stimulation (TMS) won’t usually make depression worse, but some people experience a temporary symptom increase, which is referred to as the “TMS dip.” When this occurs, it may feel like treatment isn’t working, but this isn’t usually the case. Here’s what’s likely happening instead.

Quick answers

• Can TMS make depression worse? While some people experience the “TMS dip” as depression symptoms return or slightly increase,  the dip is temporary.
• If you’re concerned about worsening symptoms or uncomfortable side effects during treatment, talk to your mental health provider. They can help assess if treatment should be adjusted.

The “TMS dip:” Why some patients feel worse before they feel better

“Patients sometimes experience a dip between the first and about middle sessions,” says Jennifer Ramsey, PMHNP,  a psychiatric nurse practitioner at Radial, “It's not necessarily expected, but if it happens, it's not unusual, and we just keep going with the treatment.”

This dip during TMS therapy is even documented in some clinical case reports, though not in many clinical trials. Take, for example, a 2025 case study in Harvard Review of Psychiatry. Around midway through treatment, the patient reported depression symptoms returning, though this was temporary. 

When symptom changes are a red flag

There are instances when a symptom flare may be more of a concern. Ramsey says two big red flags are:

• Worse symptoms than ever before: If the depression symptoms feel worse than they did at any point before treatment, this is a red flag to talk to a healthcare provider. 
• Suicidal ideation: There is no documented link between TMS and increase in suicidal ideation; in fact, a 2024 study in the Journal of Mood and Anxiety Disorders suggests TMS may decrease suicidal thoughts. Still, if experiencing suicidal thoughts while doing TMS or at any other time, immediate help is available via the 988 Lifeline. 

What to do if you think TMS is making you feel worse

Often, a mood "dip" occurs during the first few days of treatment, before more sustained therapeutic benefits are realized. While this can feel discouraging, it's an expected part of the process before the treatment fully takes hold. When the dip is minor, Ramsey recommends turning to positive intentions, practices like breathwork, and your support system. 

If symptoms look like the red flags above or the treatment response isn't what you expect, share those concerns with a provider. They can adjust the treatment protocol, session frequency, or pulse intensity so it better suits your needs. 

Some patients benefit from additional therapeutic or pharmacological support mid-course. Your  provider can help coordinate that extra support after discussing your concerns.

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