Why TMS Makes Some Patients Feel Worse Before Getting Better

If you’re in week 2 or 3 of TMS treatment and suddenly feel worse than before you started, you’re not broken. You’re not a failed case. And you’re definitely not alone. What you’re experiencing has a name, and it typically passes.

Here’s a scenario I see in my Mercer Island TMS clinic more often than you’d think.

A patient comes in for treatment session 8 or 9. They were optimistic when they started. Maybe even hopeful for the first time in years. But today? Today they look deflated. Sometimes tearful. They say something like:

“I think TMS is making me worse. I feel more depressed than before I started. Should I quit?”

And I completely understand why they feel that way. When you’ve tried multiple antidepressants, when you’ve already been through the exhausting cycle of hope and disappointment, and then this new treatment that was supposed to be different suddenly seems to be backfiring? That’s terrifying.

But here’s what I tell them — and what I want to tell you if you’re reading this from Seattle, Bellevue, Kirkland, or anywhere else and Googling “TMS made me worse” at 2am.

What Is the TMS Dip?

The TMS dip — sometimes called the “mid-treatment dip” — is a temporary increase in depression or anxiety symptoms that some patients experience partway through their TMS treatment course.

Instead of the gradual improvement you might expect, you suddenly feel like you’re sliding backward. Symptoms that had started to lift come rushing back. Some patients even report feeling worse than they did before starting treatment.

For patients in the Eastside communities — Redmond, Issaquah, Newcastle, Renton — who’ve already tried multiple treatments without success, this can feel devastating. You finally found the top-rated TMS provider in your area, you committed to the 6-week treatment schedule, and now this?

But here’s something important to understand: the TMS dip is a recognized phenomenon, documented in clinical practice and discussed extensively by the Clinical TMS Society. It’s not something clinics made up to keep patients from quitting. It’s a real pattern that we see repeatedly.

Why Does TMS Make You Feel Worse Before Better?

Let me explain what’s actually happening in your brain during TMS treatment — because understanding the “why” can make the dip a lot less scary.

Depression isn’t just “feeling sad.” Brain imaging studies show that people with depression have reduced activity in specific regions, particularly the left dorsolateral prefrontal cortex (DLPFC). Think of it as a section of your brain that’s been running on low power for months or years.

During TMS, we deliver magnetic pulses to that underactive area. These pulses generate small electrical currents that stimulate those sluggish neurons. Over time, this repeated stimulation helps your brain form new neural pathways and restore normal function.

But here’s the thing: your brain has been operating in “depression mode” for a long time. It’s adapted to that state. When we start disrupting those patterns with TMS, your brain has to reorganize. And that reorganization process isn’t always smooth.

The Neuroscience Behind the Dip

Several theories explain why the dip happens:

Neural pathway disruption. TMS disrupts the existing neural “habits” your brain has formed around depression. During this disruption period — before new, healthier pathways are established — you may experience a temporary worsening of symptoms.

Energy demands. Creating new neural connections requires significant metabolic resources. Your brain is essentially under construction, which can temporarily affect mood regulation.

Unmasking effect. Some researchers suggest that TMS may initially “unmask” underlying symptoms that were being suppressed, rather than creating new symptoms.

Individual brain chemistry. How your specific brain responds to magnetic stimulation depends on factors like your baseline neural activity, medication interactions, and even sleep quality.

What Patients Are Really Saying Online

I regularly check forums and patient communities to understand what people are experiencing with TMS. Here are some of the most common concerns I see — along with my responses.

Real Questions from Real Patients

Dr. Erkut responds to common TMS concerns

Dr. Cara Erkut, MD

Board-Certified Psychiatrist • TMS Program Director

“I’m in week 2 of TMS and I feel more depressed than before I started. I had 2 good days early on, but now I feel like I’m sliding backward. Should I quit? I’m afraid TMS is making me worse.”

This is exactly what the TMS dip looks like, and week 2 is exactly when it tends to hit. Those early good days you experienced? That’s actually a positive sign — it means your brain was responding to the stimulation. The dip you’re feeling now is likely your brain adjusting to the changes. Most patients push through this within a week and start seeing consistent improvement by weeks 4-5. I wouldn’t recommend stopping unless your provider advises it. The worst thing you can do is quit mid-treatment — that’s like stopping antibiotics halfway through. Talk to your TMS team about how you’re feeling.

“I’m halfway through treatment and want to quit. The sessions hurt and I cry on the drive there knowing what’s coming. I haven’t had a good day in 4 years and if this isn’t working, I’m out of options.”

First, I’m sorry treatment has been this painful for you. Physical discomfort during TMS should be addressed — please tell your treater so they can adjust the intensity or positioning. As for wanting to quit halfway through: I understand that exhaustion. But here’s what I’ve seen repeatedly in my practice: patients who felt nothing at session 18 sometimes have significant breakthroughs by session 30. The brain doesn’t operate on our timeline. That said, if you’re genuinely suffering, your provider can discuss whether modifications might help. Don’t suffer in silence — speak up about both the physical discomfort and the emotional struggle.

“My anxiety got WAY worse during TMS. I was being treated for depression but now I’m more anxious than ever. Did they mess something up? Is this normal?”

Increased anxiety during TMS treatment for depression is actually well-documented. Here’s why it might happen: depression and anxiety often coexist, and stimulating brain regions that affect mood can temporarily affect both. Additionally, as depressive symptoms begin to lift, some patients become more aware of underlying anxiety that was previously “masked” by the depression. The good news? This usually settles down. Tell your provider about the anxiety increase — we can sometimes adjust treatment parameters or add right-sided stimulation specifically targeting anxiety. Don’t assume something went wrong. This is more common than you’d think.

“I felt AMAZING after week 4 of TMS — like a completely different person. Then after the last treatment, it all went away. It’s been 3 weeks and I’m back where I started. Did the treatment just… wear off?”

This experience — feeling wonderful during treatment then losing it afterward — happens to some patients and can be absolutely crushing. Here’s what we know: TMS effects don’t always stabilize immediately after treatment ends. Some patients continue improving in the weeks following their last session. Others experience a temporary setback before stabilizing. And yes, for some patients, maintenance treatments are needed. If you’ve relapsed after initial success, you may be a candidate for a second course of TMS or periodic “booster” sessions. Research shows that patients who respond once typically respond again. Contact your TMS provider to discuss your options.

How Long Does the TMS Dip Last?

This is probably the question I get asked most often during that difficult week 2-3 period. And I wish I could give you a precise answer, but the reality is that it varies.

For the majority of patients who experience a dip, it lasts 3 to 7 days. Rarely, it can persist for up to two weeks. If your symptoms have significantly worsened and haven’t improved by week 4, that’s when we need to have a more serious conversation about your treatment plan.

What Should You Do If You’re Experiencing the Dip?

If you’re currently in the middle of a TMS dip — whether you’re in Seattle, on Mercer Island, or commuting from Renton or Issaquah for treatment — here’s my practical advice:

1. Tell Your Treatment Team

Don’t suffer in silence. Your TMS provider needs to know what you’re experiencing. We track patient symptoms throughout treatment for exactly this reason. Documenting your dip helps us monitor your progress and reassure you when you’re on track for recovery.

2. Don’t Stop Treatment

I know this is hard to hear when you’re feeling worse, but stopping mid-treatment is like stopping antibiotics because you’re not feeling better on day 3. The full treatment course matters. Incomplete treatment often means incomplete results.

3. Maintain Your Self-Care Basics

This isn’t the time to let sleep, nutrition, and movement slide. Your brain is working overtime right now. Give it the resources it needs:

• Aim for 7-8 hours of sleep (even if depression is disrupting it)
• Eat regular meals — your brain needs glucose
• Light movement or walking can help
• Limit alcohol, which can interfere with treatment

4. Reach Out for Support

If you’re working with a therapist, let them know what’s happening. If you have trusted friends or family, lean on them during this period. The dip is temporary, but you don’t have to white-knuckle through it alone.

5. Remind Yourself This Is Expected

Print this out if you need to: The dip is a recognized phenomenon. It affects about 1 in 5 patients. It typically passes within a week. Experiencing it doesn’t mean treatment is failing.

When Is It Actually a Problem?

While the TMS dip is usually harmless and temporary, there are situations that require immediate attention from your provider:

That last point is important. TMS is FDA-approved for major depressive disorder, but it’s not approved for bipolar depression. In some cases, TMS can trigger manic symptoms in patients with undiagnosed bipolar disorder. If you’re experiencing unusually elevated mood, decreased need for sleep, racing thoughts, or impulsive behavior — especially if you’ve never experienced these before — contact your provider immediately.

This is one reason why working with a board-certified psychiatrist for your TMS treatment matters. At our practice on Mercer Island, we conduct thorough diagnostic evaluations before starting treatment to identify patients who might be at higher risk.

Frequently Asked Questions About the TMS Dip

Written By

Cara J. Erkut, M.D.

Board-Certified Psychiatrist | Psychoanalyst | TMS Program Director

Dr. Erkut is a board-certified psychiatrist and psychoanalyst practicing on Mercer Island, WA. She earned her medical degree from Mayo Medical School and completed her psychiatry residency at the University of Washington, where she served as Chief Resident. She is an active member of the Clinical TMS Society and serves as a Clinical Instructor at UW Harborview Medical Center. Read full bio →