Can You Do TMS While on Antidepressants?

Can you do TMS while on antidepressants? Yes — in fact, people commonly start TMS while continuing the antidepressants that haven't been able to get rid of depression well enough on their own. "We encourage patients to continue their established treatment plan with their prescribing psychiatrist," says Ava Meyer, PMHNP-BC, MSN, APRN, a Psychiatric Nurse Practitioner at Radial. TMS is often added to an existing plan for treatment-resistant depression rather than requiring another antidepressant switch. 

This article explains which medications may require additional review before you start TMS, and how your care team will monitor your antidepressants before, during, and after treatment. 

Quick answers:

• Many people continue taking their antidepressants during TMS — and telling your provider about your medications before treatment starts is standard.
• Medications that lower a person's seizure threshold may require closer review during intake, but they don't automatically exclude you from TMS.
• Some patients choose to revisit their medication after successful treatment, but it's not a condition of starting treatment, and any changes will be guided by your provider.

What your medication list means for TMS

Your treatment team will review all of your prescription medications, over-the-counter medications, and supplements before you begin transcranial magnetic stimulation. "While we generally advise against making multiple medication changes during the TMS treatment course, we understand that changes may sometimes be clinically necessary," Meyer explains

Medication safety includes informing your provider about all medications you're taking, which is a routine part of the TMS assessment. Most medications are not a barrier to treatment. Medications that interfere with TMS are uncommon, but there may be situations that require additional monitoring. Medications they consider include: 

• Most antidepressants (SSRIs, SNRIs, common atypicals): SSRIs and TMS are commonly used together, and you can continue your medication as prescribed throughout treatment. No changes are needed in the majority of cases.
• Medications that lower seizure threshold: Certain medicines, including some tricyclic antidepressants and bupropion, may prompt a closer look during intake because they raise your seizure risk,  according to recommendations published in the Journal of Clinical Psychiatry. However, these don't automatically exclude someone from TMS therapy.
• Benzodiazepines: These medications may reduce TMS response rates, per research published in Brain Stimulation. If you are prescribed benzodiazepine medications, your treatment team will advise you on the safest way to get the most out of your TMS treatment.

What happens to your antidepressants during and after TMS?

For the majority of people, their antidepressant medications will remain unchanged throughout the course of TMS treatment unless their provider recommends otherwise. Starting, stopping, or adjusting your antidepressants on your own can make it more difficult to evaluate your response to treatment and might complicate how providers coordinate care, Meyer says.

After a strong response to TMS, some patients may discuss reducing their antidepressant regimen with their treatment team. Meyer says these conversations typically occur only after symptoms have stabilized and providers are confident that treatment gains have been maintained.

Rather than stopping medications abruptly, providers typically use a gradual tapering process while monitoring for symptom recurrence or withdrawal effects. "If any side effects or reemergence of symptoms occur, this may signal that it may be necessary to slow the downward titrations of psychiatric medications," Meyer explains.

The most important step before, during, and after TMS is maintaining communication with your treatment team. Any medication changes should be coordinated through the providers responsible for your care rather than made independently. Meyer says that TMS providers often work directly with a patient's existing psychiatric prescriber when medication questions come up to ensure that treatment decisions are consistent across the care team.