Transcranial magnetic stimulation (TMS) therapy can be used as an alternative treatment method for those who have failed to tolerate or respond to various classes of antidepressants, or it can be used to augment the effects of medication. The clinical research trials on TMS have included studies where participants discontinued antidepressants as well as studies which have include subjects taking antidepressants. Both types of studies have shown that TMS is an effective and safe treatment, either as monotherapy or as a strategy for treating breakthrough symptoms in those who are taking antidepressants.
Prior to beginning TMS, Dr. Cohen will obtain a comprehensive history of medication you have tried. He will use this information to decide on the best treatment plan. If medication has been ineffective, it is typically continued through the initial phase of TMS treatment and slowly tapered off. In some cases, medication is discontinued prior to TMS, for example, if side effects make the medication intolerable. If medications have been partially effective, they may be continued for the duration of TMS therapy.
Medications for anxiety are often prescribed to patients considering TMS. Research and clinical experience suggest that benzodiazepines, including Klonopin, Ativan, Valium, and Xanax, may interfere with TMS. Use of these medications should not be stopped abruptly. Dr. Cohen will discuss with you the proper dosing of benzodiazepines to allow for the greatest treatment efficacy. It is usually best to take no more than a low to moderate dose of benzodiazepine while undergoing TMS.
On a case by case basis, patients prescribed higher doses of benzodiazepines may be able to proceed with TMS. This is because the Neurostar is often able to compensate for the effects of the benzodiazepine. Whether the Neurostar can effectively treat a given patient on high doses of benzodiazepines becomes apparent during the initial treatment session. If the benzodiazepine is found to interfere in the treatment, the patient will be instructed to reduce the benzodiazepine dose prior to resuming treatment.
At Principium Psychiatry, Dr. Cohen and the rest of the treatment team work closely with each patient’s primary psychiatrist to make the most appropriate treatment plans regarding psychopharmacology and TMS use. In many cases, the patient will choose to have Dr. Cohen be the primary psychiatrist as well as the TMS psychiatrist, in which case Dr. Cohen will directly advise and manage the patient’s medications.*
*This blog post is meant to provide general information about TMS medication use. It is not to be construed as medical advice. Individuals are encouraged to speak with their treating physician regarding questions about their medication regimens.