“I’m in week 2 of TMS and I feel WORSE than before I started. More anxious, more depressed, crying more. Is this normal or should I stop?”

What you’re describing sounds like the “TMS dip” and it’s actually more common than people realize. Around weeks 2-3, some patients experience a temporary worsening of symptoms before things improve. Your brain is adjusting to the stimulation. Most patients push through this within a week and start seeing improvement by weeks 4-5. It’s counterintuitive, but this dip can actually be a sign that your brain is responding to the treatment. Please don’t stop without talking to your provider. The patients who see the best results are often the ones who pushed through this difficult period.

“Started TMS for depression but my anxiety has gotten so much worse. I can barely function. Is this supposed to happen?”

This is a well-documented phenomenon. Depression and anxiety often coexist, and as TMS stimulates the areas of your brain involved in mood regulation, things can feel stirred up before they settle. Think of it like physical therapy. Sometimes you feel worse before you feel better as things are being reorganized. Talk to your provider about what you’re experiencing. They may be able to adjust the treatment parameters. For most patients, this heightened anxiety is temporary and resolves as treatment progresses. The key is communication with your treatment team.

“I’m terrified to try Spravato. I’ve read about people having horrible experiences with dissociation and feeling like they’re dying. Is it really worth the risk?”

Your fear is understandable given what you’ve read. Here’s some context: dissociation during Spravato varies widely between patients. Some feel very little, others more. The “existential dread” experiences you’ve read about, while real for some people, are not the norm. What makes Spravato different from recreational ketamine is the controlled medical setting. You’re monitored the entire time, the dose is standardized, and medical staff are right there if you’re uncomfortable. Many of my patients who were initially terrified have found the experience far more manageable than they expected. We can also start with a lower dose and adjust based on your response.

“I’ve tried 8 different medications and nothing works. I’m starting to think I’m just broken and nothing will ever help. Is treatment-resistant depression even treatable?”

You are not broken. You have treatment-resistant depression, which is a recognized medical condition that affects roughly 30% of people with depression. It’s frustrating and exhausting, I know. But here’s what matters: the fact that oral medications haven’t worked doesn’t mean nothing will work. TMS and Spravato were specifically developed for people like you, and they work through completely different mechanisms than traditional antidepressants. I’ve seen patients who failed 10+ medications finally find relief with these treatments. Don’t give up. We have more tools now than ever before.

“My teenager seems depressed but refuses to talk to anyone. How do I know if this is just normal teenage angst or something serious?”

Trust your instincts. Normal teenage moodiness comes and goes. Depression persists. Watch for: withdrawal from friends and activities they used to enjoy, declining grades, sleep changes (too much or too little), loss of interest in things they once cared about, and especially any talk of hopelessness or self-harm. If symptoms last more than two weeks and interfere with their functioning, it’s time to act. You don’t need their permission to be concerned. Try framing professional help as “coaching” rather than something being wrong with them.

“My doctor wants to put me on antidepressants but I’m scared about the side effects, especially weight gain and sexual dysfunction. Are these really worth it?”

Your concerns are valid. Here’s what I tell patients: not all antidepressants cause the same side effects. Weight gain and sexual dysfunction are more common with some medications than others. Bupropion (Wellbutrin), for example, typically doesn’t cause either. Tell your prescriber what side effects concern you most BEFORE starting. We can often choose options that minimize those specific risks. And here’s the tradeoff to consider: untreated depression also affects weight, energy, relationships, and sex drive. Often more than the medication would.

“The TMS tapping is really uncomfortable and giving me headaches. I want to quit. My provider says to push through but it’s affecting my quality of life.”

Physical discomfort during TMS should be addressed. Please tell your treater so they can adjust the intensity or positioning. The headaches are common in the first week but should improve. Over-the-counter pain relievers before sessions often help. As for wanting to quit: I understand that exhaustion. But here’s what I’ve seen repeatedly: patients who felt nothing at session 18 sometimes have significant breakthroughs by session 30. The brain doesn’t operate on our timeline. Speak up about both the physical discomfort and the emotional struggle.

“I feel like I’m just going through the motions in therapy. We talk but nothing changes. How do I know if therapy is actually working?”

This is such an important question. First: bring this exact concern to your therapist. Good therapy involves openly discussing how therapy is going. Signs that therapy IS working include: you’re more aware of your patterns (even if you haven’t changed them yet), you feel understood, you’re thinking about things differently outside sessions, or relationships are shifting. Change often happens gradually. But if after several months you genuinely feel stuck, it may be time to discuss a different approach or consider whether this particular therapist is the right fit.

“I stopped my Zoloft cold turkey because it wasn’t working and now I feel horrible. Brain zaps, dizziness, flu-like symptoms. What’s happening to me?”

What you’re experiencing sounds like antidepressant discontinuation syndrome. It’s your brain readjusting to the absence of medication it had adapted to. The “brain zaps” are classic. This can happen even with medications that didn’t seem to be helping because your brain still adjusted to their presence. Please contact your prescriber. They may recommend restarting at a lower dose and tapering more gradually. Never stop antidepressants suddenly without medical guidance.

“I’ve heard TMS can cause seizures. My provider says the risk is less than 0.1% but that still terrifies me. Should I be worried?”

Your concern is understandable, but let me put that number in context. The seizure risk with TMS is less than 0.1% per patient, which is comparable to the seizure risk associated with many antidepressant medications. We screen carefully for seizure risk factors before starting treatment. In over 6.6 million TMS sessions performed with the NeuroStar system, serious adverse events have been extremely rare. The risk is not zero, but it’s very small and comparable to treatments you might already be taking.

“My anxiety gives me chest pain and I can’t breathe. I’ve been to the ER twice and they say my heart is fine. But it feels SO real. Am I crazy?”

You are absolutely not crazy. Anxiety can cause very real, very frightening physical symptoms including chest pain, shortness of breath, racing heart, and a sense that something is terribly wrong. Your body’s stress response doesn’t know the difference between a real threat and anxiety. What you’re experiencing is likely panic attacks or severe anxiety. The good news: these are very treatable. Once you understand what’s happening physiologically and have tools to manage it, these episodes typically become less frequent and less intense.

“I finally feel better on my antidepressant. How do I know when it’s safe to stop taking it? I don’t want to be on medication forever.”

Feeling better is wonderful, and your desire to eventually stop medication is understandable. General guidelines suggest staying on medication for at least 9-12 months after feeling better for a first episode of depression. This significantly reduces relapse risk. For people with recurrent episodes, longer treatment may be recommended. When you do stop, never do it suddenly. We taper gradually over weeks to months to minimize discontinuation symptoms and watch for returning depression.

“I feel emotionally numb on my antidepressant. Not depressed exactly, but not happy either. Just flat. Is this what ‘better’ is supposed to feel like?”

What you’re describing is called “emotional blunting” and it’s a recognized side effect of some antidepressants, particularly SSRIs. This is NOT what “better” should feel like. You should be able to experience a full range of emotions, including joy. Please bring this up with your prescriber. Options include adjusting your dose, adding another medication to counteract this effect, or switching to a different antidepressant that’s less likely to cause emotional blunting. Don’t settle for feeling numb.

“Found out my 15-year-old has been cutting. I’m terrified and don’t know what to do. Is this a suicide attempt?”

First, take a breath. Cutting is serious and needs professional attention, but it’s usually not a suicide attempt. For most teens, cutting is a way of coping with overwhelming emotional pain. It provides a temporary release or sense of control. That said, self-harm does increase suicide risk over time. Approach your teen with calm concern, not anger. Let them know you see they’re hurting and you want to help them find better ways to cope. Get a professional evaluation. With proper support, most teens who self-harm can learn healthier coping strategies.

“I finished TMS 6 months ago and it really helped. But now I feel depression creeping back. Does this mean the treatment failed?”

No, it doesn’t mean the treatment failed. TMS provided real relief that lasted for months. Some people need periodic “maintenance” or “refresher” courses of TMS to sustain their improvement, similar to how some conditions require ongoing treatment. The fact that you’re noticing symptoms returning early is actually good. Catching it now means we can intervene before you’re back to where you started. Contact your provider about maintenance TMS options.

“Why should I see a psychiatrist when my regular doctor can prescribe the same medications?”

Your regular doctor can prescribe many psychiatric medications, and for straightforward cases, that may work fine. But psychiatrists have 4+ additional years of specialized mental health training. We see more complex cases, know the nuances of different medications, and have access to treatments like TMS that primary care doctors don’t offer. If you’ve tried one or two medications without success, have multiple diagnoses, or want access to advanced treatment options, a psychiatrist can provide a level of expertise that makes a difference.

“How do I find a good psychiatrist? I’ve had bad experiences and don’t trust the process anymore.”

Bad experiences with mental health providers are unfortunately common and your wariness is understandable. A good psychiatrist should listen more than they talk in early appointments, explain their reasoning and involve you in decisions, take your concerns seriously without dismissing them, and be reachable between appointments for urgent concerns. Trust your gut. If something feels off, it’s okay to seek a second opinion. Ask friends, your therapist, or your primary care doctor for recommendations.

“I’ve had anxiety my entire life. Is it even possible to get better or am I just stuck with this forever?”

Lifelong anxiety can absolutely improve with proper treatment. Some people do have an anxious temperament that may never fully disappear, but there’s a huge difference between having anxiety and being controlled by it. Treatment can help you understand your triggers, develop coping tools, reduce the intensity and frequency of anxiety, and live a full life despite it. Many of my most anxious patients have learned to manage their anxiety so well that it no longer runs their lives. It takes work, but improvement is absolutely possible.

“I’m worried TMS will change my personality. Will I still be ‘me’ after treatment?”

This is such a thoughtful question. TMS doesn’t change who you are. It lifts the fog of depression that’s been obscuring who you are. Patients often tell me they feel more like themselves after TMS, not less. They rediscover interests, energy, and ways of relating to others that depression had taken away. Your core personality, your values, your sense of humor remain intact. What changes is that depression is no longer sitting on top of everything, dulling your experience of life.

“TMS requires 5 days a week for 6-7 weeks. I can’t take that much time off work. Is there any way to make this more manageable?”

The time commitment is real and I understand it’s challenging. Each session is only about 19 minutes, so many patients schedule sessions early morning before work, during lunch, or right after work. You can drive immediately after and return to normal activities. Some employers accommodate medical appointments, and treatment for depression may qualify for FMLA protection. We can also provide documentation for your employer. The investment of time now can save months or years of struggling with depression.