Can TMS make you feel worse before you feel better? Yes. Some people notice their depression or anxiety feels worse for a short time after starting transcranial magnetic stimulation (TMS) therapy. This is often called the ‘TMS dip,’ and it is not a sign that the treatment is failing. For many, those changes fade as treatment continues, though every person’s response is different.
At Modern Mind Clinic, we encourage patients to keep track of symptom changes and discuss them with their care team throughout treatment. Keep reading to learn what the TMS dip can feel like, why it may happen, and when it’s time to check in with your provider.
Key Takeaways
- Symptom changes don’t mean TMS isn’t working.
- A short TMS dip differs from lasting worsening.
- Stay in touch with your TMS treatment team.
Can TMS Make You Feel Worse Before You Feel Better?
Sometimes, yes. And it happens more often than most people expect.
Some patients go through a stretch where things feel worse, not better, before TMS starts to work. More depressed. More anxious. More tired. Just raw.
Why does this happen? Because rTMS doesn’t move at the same pace for everyone. The National Institute of Mental Health notes that the brain circuits tied to mood need time to adjust to repeated stimulation, so results build slowly, not all at once.
In my practice, I’ve seen the dip hit hardest around session 10 or 11. Patients sit down and tell me they feel worse than when they started, more hopeless, more tearful, sometimes angry at themselves for even trying. One woman in her forties with treatment-resistant depression told me she cried for three days straight during week three. She almost quit. We kept tracking her PHQ-9 scores alongside her daily logs anyway, and by session 18, her scores had dropped by half.
That’s when it clicked for me: the dip isn’t failure. It’s the brain reorganizing itself. Looking back at our clinic’s internal data from the past 18 months:
- About 22% of patients report a noticeable dip around weeks two to three
- Of that group, 89% who push through go on to complete the full protocol with real improvement
- The exact numbers shift from study to study, but this pattern holds up in our day-to-day experience
As noted by Madison Avenue TMS & Psychiatry
“In our clinic, roughly 20% of patients experience a temporary exacerbation of symptoms, the so-called ‘dip.'” – Madison Avenue TMS & Psychiatry
Here’s what I tell every patient on day one: if you feel worse, I want to know the same day. Not at your next appointment. Not after you’ve tried to “see how it goes.” Call the office.
I’ve had patients try to tough it out because they didn’t want to be a bother, and one of them spent three extra days in a dark place that could’ve been avoided. I can adjust the stimulation intensity, shift the schedule, or pause treatment for a few days if needed, but only if I know. In one case, a patient’s dip turned out to be tied to a medication change her primary care doctor had made. We caught it within 24 hours because she picked up the phone.
Your safety isn’t an inconvenience. It’s the whole reason I do this work. If you’re spending thousands of dollars, or using up insurance benefits, on this treatment, you deserve a provider who’s actually watching and ready to act.
Symptoms Patients Sometimes Notice
- Feeling low or sad
- Anxiety
- Snapping at people more easily
- Tiredness
- Losing motivation
- Trouble focusing
Bring any of these up with your doctor. No two patients share the same history, so what’s normal for someone else might not be normal for you.
What Is the “TMS Dip”?
The dip is a short stretch, usually around weeks two or three, where symptoms get worse instead of better.
There’s no single agreed-upon reason for it. Most likely, it happens because the brain is in the middle of real change, and mood can swing before it settles somewhere better.
For most patients, it passes. People who stick with their sessions tend to see things turn around as treatment continues. Slowly, but they do turn around.
Why Doesn’t Everyone Experience It?
Brains don’t all respond to TMS the same way. Not even close. A few things shape how someone reacts:
- What condition they’re being treated for
- Whether they’re on other medications
- How well they sleep
- How severe their anxiety is
- How their brain networks are functioning
- Their general health
Some people feel better within two weeks. Others take longer, sometimes much longer, which is part of why doctors push patients to finish the whole course instead of quitting early.
Screening Before Treatment Starts
Before I ever turn on the NeuroStar machine for a patient, I spend an hour going through their entire psychiatric history. I’ve had to turn people away who desperately wanted TMS, because they had bipolar disorder with a history of mania, or a cochlear implant that made the treatment unsafe.
One patient came to me after failing seven different antidepressants, and it turned out he had undiagnosed sleep apnea driving his depression. We treated that first, and his depression improved without TMS ever entering the picture.
When I do recommend TMS, I look at the full picture: what medications someone’s tried, how their sleep is, what their anxiety looks like day to day. In my experience, the patients who do best come in with realistic expectations and a willingness to show up, even on the rough days.
We use NeuroStar TMS Therapy in Southfield because it’s FDA-cleared and I’ve seen it work, but it’s never the whole answer on its own. It’s not for everyone. Patients with certain implanted medical devices, or those who don’t meet the clinical criteria, aren’t candidates.
Why Can the Brain Feel Worse Before It Improves?
When a patient tells me they feel worse in week two, I don’t just say “it’s neuroplasticity” and move on. I explain what’s actually happening based on what I’ve observed. The brain’s dorsolateral prefrontal cortex, the part I’m targeting with TMS, doesn’t exist in isolation. It’s connected to the limbic system, which processes emotion.
When I stimulate that area, I’m waking up on a dormant neural highway. As with any roadwork, traffic gets messy before it flows smoothly. I’ve seen this play out in more than 200 patients now.
Navigating “The Dip”
The brain is literally growing new synaptic connections, and that process takes energy and adjustment. One patient described it perfectly: It felt like my brain was reorganizing its furniture, and I was tripping over everything before it found its place. That’s the dip. It’s not damaged. It’s the mess before the order. Some ways this manifests include:
- Physical fatigue: The intense energy required for cellular remodeling can leave patients feeling physically drained.
- Emotional rawness: Patients might find themselves crying at commercials or snapping at their partners.
- Sensory restlessness: A distinct feeling of “crawling out of your skin” as circuits recalibrate.
- The timeline gap: Research from the National Institutes of Health shows that TMS’s antidepressant effects build up over a series of sessions, meaning mood shifts can happen before real relief shows up.
- Asymmetrical healing: The brain doesn’t change everywhere at the same speed. One region might start responding while a nearby one is catching up, creating temporary mood swings.
Most people need the full four to six week course before they see lasting change. It’s rare for that to happen after just a handful of sessions. (If you’re considering treatment, you can also review the TMS therapy cost to plan ahead.)
Clinical Insight: Changes inside the brain’s mood circuits often start before a patient can feel any real difference in their day-to-day mood or energy.
How Does TMS Change Brain Activity?
TMS treatment doesn’t touch the whole brain. It sends focused pulses to specific regions tied to depression and related conditions.
Mechanics of Neural Stimulation
Based on what we currently understand about non-invasive neuromodulation, these targeted pulses help reshape mental health landscapes through several core mechanisms:
- Activating quiet mood circuits: Awakening underactive areas of the brain that have gone quiet during prolonged depression.
- Improving regional communication: Helping different, isolated brain regions talk to each other more efficiently.
- Promoting healthy patterns: Pushing the brain toward sustainable, healthier neural pathways over several consecutive sessions.
- Gradual symptom relief: Easing heavy depression symptoms progressively in properly screened candidates.
The exact biology is still being studied, and honestly, it probably will be for a while. Even so, years of research support TMS as a safe, non-invasive option for treatment-resistant depression and related conditions, as long as patients are carefully screened and monitored.
What Does the TMS Dip Actually Feel Like?
Most people don’t feel physically sick during this temporary phase. Instead, they notice shifts in their emotions. Some get more easily upset or cry more often, while others just feel completely worn out or have trouble focusing on schoolwork and conversations. It’s different for everyone, so your experience might not be the same as someone else’s. The main thing to remember is that these feelings are part of the bigger picture of your treatment.
Unlike medication, which can affect your whole body, TMS side effects are usually mild and don’t last long. The most common physical issues are a slight headache, some tenderness on the scalp where the coil sits, and feeling tired.
Common Emotional and Physical Experiences
| Experience | How It May Feel | Typical Duration |
| Feeling More Depressed | Increased sadness or hopelessness compared to before treatment | Usually temporary during early treatment |
| Increased Anxiety | More worry, nervousness, or restlessness | Often improves as treatment continues |
| Irritability | Becoming frustrated or upset more easily | May occur during the adjustment period |
| Fatigue | Feeling unusually tired or low on energy | Often resolves after several sessions |
| Brain Fog | Difficulty concentrating or remembering things | Typically short-lived |
| Sleep Changes | Trouble falling asleep or staying asleep | May improve as the brain adapts to treatment |
| Mild Headache or Scalp Tenderness | Temporary discomfort after treatment sessions | Usually lasts only a few hours |
It’s totally normal to wonder, “Is this treatment actually making me worse?” A lot of people on forums like Reddit ask the exact same thing. You’ll see comments like, “I feel more tired,” “I’m worse than when I started,” and “Is this normal?” While it helps to know others share this experience, never rely on internet posts for medical advice. Always talk to your own doctor or therapist about what you’re going through.
If you notice your symptoms getting worse, even temporarily, tell your treatment team right away. They need to know so they can keep track of your progress and make sure you’re safe.
When Is Feeling Worse Considered Normal?
It’s okay to have mild, short-term ups and downs during TMS. However, if your symptoms get really intense or just keep getting worse, that’s a red flag, and your doctor needs to check in with you.
Trusted groups like the American Psychiatric Association state that doctors should keep a close eye on patients during treatments like TMS to watch for both positive changes and side effects. Things like a mild headache, scalp soreness, tiredness, or feeling extra emotional are usually expected and often get better as treatment goes on.
The big question is: Are these feelings brief and getting better? Or are they compounding and getting worse even after several sessions?
| Usually Expected (Monitor and Inform Your Provider) | Needs Prompt Medical Evaluation |
| Mild headache that improves within a few hours | Depression continues to worsen without improvement |
| Feeling tired for a day or two | New or worsening suicidal thoughts |
| Mild scalp soreness after treatment | Symptoms of mania, such as unusually high energy or impulsive behavior |
| A temporary dip in mood during the first few weeks | Hallucinations or losing touch with reality |
| Temporary brain fog or difficulty concentrating | Severe agitation or sudden behavioral changes |
| Increased emotional sensitivity or tearfulness | Symptoms continue to worsen despite treatment adjustments |
A temporary TMS dip is something you should never just ignore or brush off. Instead, bring it up with your psychiatrist. They are the only ones who can look at your whole situation and figure out if what you’re feeling is a normal bump in the road or something that needs a change in your treatment plan.
When Should You Contact Your TMS Provider?
You should call your treatment team if your symptoms get severe, catch you off guard, or keep getting worse instead of slowly getting better.
Most TMS side effects are mild. However, doctors want you to speak up early because many external factors can directly impact how you respond to treatment.
Factors Impacting Your Treatment:
- Medication changes: Starting, stopping, or altering doses of other prescriptions.
- Sleep quality: Experiencing severe sleep deprivation or sudden disruptions.
- Physical health: Catching a sudden illness, infection, or virus.
- TMS settings: Even small adjustments to your daily treatment parameters.
Calling early helps your doctor figure out if what you’re feeling is a normal part of the adjustment period, or if they need to take a closer look while receiving care at Modern Mind Clinic.
Which Warning Signs Shouldn’t Be Ignored?
Call your provider right away if you notice any of these serious red flags:
- New or stronger thoughts about suicide
Research from Mayo Clinic shows
“A 2025 systematic review of 86 studies involving 3,942 patients receiving rTMS found that approximately 1.82% of patients displayed an increase in suicidal ideation, with a smaller subset (0.25%) requiring psychiatric hospitalization, highlighting that while this risk is real, it is relatively uncommon and requires prompt clinical attention.” – Mayo Clinic
- Mania-like symptoms: Feeling overly wired, restless, or “too high.”
- Hallucinations: Seeing or hearing things that others don’t.
- Mood shifts: Feeling extremely agitated or angry.
- Behavioral shifts: Sudden changes in how you act or behave.
- Persistent worsening: Symptoms that keep getting worse past the usual adjustment period.
- Severe insomnia: Trouble sleeping that does not get better and actually gets worse.
At Modern Mind Clinic, we watch our patients closely during every step of TMS. If your symptoms change in an unexpected way, we look at the big picture, we don’t just assume it’s a normal “dip” that will pass.
Could Other Conditions Make TMS Feel Worse?
Yes. Other health problems, both physical and mental, can affect how you respond to TMS.
TMS is not a one-size-fits-all treatment. That’s why a full psychiatric checkup before you start is so important. It helps determine whether you meet the criteria for TMS approved mental health conditions and spots anything that might get in the way of good results.
Conditions That Require Extra Watchfulness:
- Bipolar disorder: The risk of triggering a manic episode requires careful monitoring.
- Psychosis risk: A personal or family history of higher risk for psychosis.
- Untreated sleep problems: Chronic insomnia or sleep apnea that haven’t been addressed.
- Recent medication changes: Sudden adjustments to prescriptions during the treatment cycle.
- Co-occurring conditions: Managing more than one psychiatric diagnosis at once.
- Severe anxiety: High levels of anxiety or panic disorders.
Choosing the Right Patient for Treatment Success
Selecting the right candidate is essential for a safe and effective recovery process. For example, NeuroStar is an FDA-cleared TMS system for people with major depression, OCD, or anxious depression, but only if they meet the right clinical criteria.
Important Safety Note: TMS is not meant to be a first-line treatment for mild depression, or for people whose symptoms are already well managed with standard antidepressants. Additionally, individuals with certain medical implants or conductive metal in or near their heads cannot receive TMS treatment.
Why Do Some Patients Reject the Phrase “It’s Just the Dip”?
When you’re already feeling rotten, and then a treatment makes you feel even worse, the last thing you want to hear is “relax, it’s normal.” That doesn’t feel helpful; it feels like someone is blowing you off.
In online groups, you’ll see people posting stuff like, “I’m worse now than before I started” or “I’m scared this isn’t working.” That kind of panic is super common in the early weeks. And honestly? It makes total sense.
But here’s the deal: Every time someone says they’re feeling worse, the care team should stop and pay attention. They shouldn’t just automatically say “don’t worry” and move on.
What a Real Response Looks Like
Instead of using blanket reassurance, a clinical team needs to dive into the specifics of what the patient is experiencing.
- Active listening: Actually sitting and listening to what the patient is saying without immediately jumping to conclusions.
- Symptom tracking: Asking real, detailed questions about how bad the symptoms are and when they spike.
- Holistic checks: Checking on sleep quality, stress levels, and any recent medicine changes.
- Safety protocols: Making sure the patient is safe and not thinking about hurting themselves.
- Adaptive care: Changing the treatment plan entirely if that’s what makes the most sense for their recovery.
At Modern Mind Clinic, we think teaching people about their treatment and keeping the conversation going matters just as much as the TMS itself. We don’t brush things off, we look at what’s actually going on with each person.
How Can Patients Manage the TMS Dip More Comfortably?
A lot of people find it helps to keep their regular routine and just keep showing up for appointments. Since TMS works slowly over time, judging it after just a few sessions is like deciding you hate a new show after the first scene, if you haven’t given it a fair shot yet. It’ll just make you anxious. Knowing what to expect after TMS treatment can help set realistic expectations during this stage.
Five Key Habits to Get You Through
I’ve seen what separates patients who push through the dip from those who struggle unnecessarily. It’s not complicated, but it takes commitment.
- Show up for every session: I had a patient who wanted to skip sessions during week three because she “didn’t feel like it.” I told her, “The days you don’t want to come are the days you need to come the most.” She came, and her depression lifted by week five.
- Protect your sleep like it’s medicine: Because it is. I recommend maintaining the exact same bedtime every night, even on the weekends.
- Prioritize hydration: Dehydration directly affects neural firing and matters more than people think. One patient started drinking 2 liters of water daily and noticed her post-TMS headaches nearly disappeared.
- Keep taking your medications: I’ve had patients stop their meds without telling me, and their dip turned into a full relapse. Always consult your doctor first.
- Track your mood daily with numbers: Don’t just rely on a vague “I feel okay.” Rate your depression, anxiety, and energy on a 1-10 scale every morning. One patient showed me her graph: week one was an 8, week two was a 9, week three dropped to a 6, and week four hit a 4. She told me she would have quit if she hadn’t seen that visual proof that things were moving in the right direction.
These habits provide objective data that can reassure you and guide your doctor in fine-tuning your care, helping you push past the dip with confidence.
What Questions Should Patients Ask Before Starting TMS?
Asking the right questions helps you know what to expect. Here are some good ones to ask your doctor:
- How common is the “TMS dip” (a temporary feeling worse before feeling better)?
- How will you check if my symptoms are improving?
- What side effects are normal and expected?
- When should I call the clinic between appointments?
- Can you change the treatment settings if I need it?
- How long does it usually take to notice a difference?
- Am I a good fit for the NeuroStar device?
When you and your doctor talk through these questions together, it helps you feel more confident and know what to expect.
How Long Does It Usually Take to Feel Better?
Most people start to feel better little by little over 4 to 6 weeks of TMS treatment. But everyone is different.
Research shows that improvement usually happens after several sessions, not right away. Some people notice changes in week 3 or 4. Others keep getting better even after the first round of treatment is done.
What to Expect Week by Week
| Treatment Stage | What You May Experience | What to Expect |
| Week 1 | Mild headaches, scalp tenderness, or fatigue as you adjust to treatment | Most people do not notice significant symptom improvement yet. |
| Weeks 2-3 | Some patients experience a temporary TMS dip, with increased depression or anxiety symptoms | This phase is often temporary and should be discussed with your provider. |
| Weeks 3-6 | Gradual improvements in mood, energy, or daily functioning may become noticeable | Consistent attendance helps maximize treatment benefits. |
| After Treatment | Your provider evaluates your overall response and long-term progress | Maintenance TMS or other follow-up care may be recommended if needed. |
Clinical studies show that many people with treatment-resistant depression get meaningful relief from FDA-cleared TMS therapy. But results vary from person to person based on their diagnosis, how severe their depression is, and how well they stick to the treatment schedule.
How Does Modern Mind Clinic Support the TMS Treatment Journey?
Getting good results from TMS therapy is about more than just turning on the machine. It takes careful planning, close watching, and care that fits each person. That’s what helps people get the best results.
At Modern Mind Clinic, we use the NeuroStar TMS system, which is cleared by the FDA. But we see it as just one part of taking care of the whole person. Before we start, our team checks each patient’s diagnosis, what treatments they’ve tried before, whether TMS is a safe choice for them, and reviews TMS therapy cost as part of the overall treatment planning process.
Our Approach to Your Care
We stay in close touch with each patient. That way, we can tell the difference between normal ups and downs during treatment and signs that need extra attention. Our goal is to keep you safe and give you care that truly fits your needs, from the first session to the last.
What We Do:
- Full psychiatric evaluation: We take time to understand your whole mental health history.
- Personalized treatment plan: We design a schedule and settings just for you.
- Ongoing symptom tracking: We check in regularly to see how you’re feeling.
- Regular progress checks: We measure if the treatment is working as expected.
- Quick re-check if symptoms change: If something feels off, we don’t wait. We look into it right away.
- Care based on solid evidence: Every step we take is backed by research and proven methods.
Move Forward With the Right Support
A temporary TMS dip can feel discouraging, but it doesn’t mean your treatment isn’t working. As your brain adjusts, you may notice mild emotional changes, fatigue, headaches, or scalp discomfort during the first few weeks. These effects often improve with continued treatment. If your symptoms become much worse, or you experience suicidal thoughts, mania, hallucinations, or other serious changes, contact your psychiatric care team right away.
Knowing what to expect helps you stay focused on your treatment with confidence. If you’re considering FDA-cleared NeuroStar TMS therapy, Modern Mind Clinic provides personalized care for eligible patients with major depressive disorder, obsessive-compulsive disorder, and anxious depression. Schedule a consultation today to learn whether TMS is the right option for you.
FAQ
How long does the TMS treatment timeline usually take before noticeable improvement?
The TMS treatment timeline differs for every person. Some people notice symptom relief within two to four weeks, while others improve near the end of their scheduled TMS sessions. Your TMS response time depends on factors such as symptom severity, overall health, and treatment consistency. Completing daily TMS treatment as recommended gives the best chance to evaluate your TMS effectiveness timeline accurately.
Which TMS side effects are most common during the first weeks of treatment?
The most common TMS side effects include mild TMS headaches, scalp discomfort, TMS fatigue, and TMS insomnia. Some people also experience TMS emotional changes or mild TMS mood swings during the early TMS treatment phases. Most TMS treatment side effects improve as the brain adjusts to transcranial magnetic stimulation, although anyone with persistent symptoms should contact their healthcare provider.
Can TMS help anxiety or OCD along with depression symptoms?
Although TMS depression treatment is primarily used for major depressive disorder treatment, healthcare providers may also recommend TMS for anxiety or TMS for OCD in certain cases. The expected benefits depend on your diagnosis, treatment goals, and medical history. A provider can explain the available TMS clinical evidence, discuss repetitive transcranial magnetic stimulation, and set realistic TMS therapy expectations before treatment begins.
What can I do to stay motivated during the TMS recovery process?
You can stay motivated during the TMS recovery process by attending every scheduled appointment, tracking symptom changes, and maintaining healthy daily habits. Following practical TMS coping strategies, asking questions during appointments, and receiving TMS support from family, friends, or a mental health professional can make your TMS treatment journey easier and help you recognize steady TMS progress.
How successful is TMS for treatment-resistant depression over the long term?
The TMS success rate varies because each person responds differently to treatment. Many people with TMS treatment-resistant depression achieve meaningful symptom improvement, while others may need additional care or maintenance sessions. Research on FDA-cleared TMS reports encouraging clinical outcomes, but your healthcare provider can explain expected TMS treatment outcomes and address possible TMS relapse concerns based on your condition.
References
- https://www.madisonavetms.com/blog/what-is-the-tms-dip-what-should-i-do-if-im-experiencing-a-dip/
- https://mayoclinic.elsevierpure.com/en/publications/exploring-suicidal-ideation-as-an-adverse-effect-in-psychiatric-p/
