Can SAINT® Make Depression Worse? Understanding the 'TMS Dip'

SAINT® (Stanford Accelerated Intelligent Neuromodulation Therapy) is FDA-cleared for major depressive disorder (MDD) in adults whose depression has not improved enough on prior antidepressant medication. Some people notice a temporary dip in mood during or shortly after treatment — often called a 'TMS dip.' This is usually mild and passes within days. The 2022 SAINT® randomized trial did not report worsening of depression as a common outcome (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary.

As with any depression treatment, there is a risk of worsening symptoms or suicidal thoughts. The treatment team monitors you throughout the week and after. If you notice your mood getting worse, tell the team right away. If you are in crisis, call or text 988. The 988 Suicide and Crisis Lifeline is available 24/7, free and confidential.

If you are in crisis or having thoughts of suicide, call or text 988 right now. The 988 Suicide and Crisis Lifeline is available 24/7.

The 'TMS dip' is a term patients and clinicians use to describe a temporary worsening of mood that some people experience during or shortly after TMS treatment. It is not an official medical diagnosis, and it is not the same as the treatment not working. Think of it as an adjustment period — the brain is responding to repeated stimulation, and some people feel worse before they feel better.

The dip can show up as a drop in mood, increased tearfulness, irritability, fatigue, or a sense that things are not improving fast enough. It is usually mild. Some people do not notice it at all. Others feel it for a day or two during the treatment week or in the first week or two after treatment ends.

It is important to distinguish a dip from a genuine worsening that needs attention. A dip is temporary and mild. If your mood is dropping sharply, lasting more than a couple of weeks, or includes thoughts of suicide, that is not a dip — call your treatment team and, if you are in crisis, call or text 988.

Learn more about how SAINT® works or what treatment-resistant depression is.

In the 2022 SAINT® randomized controlled trial, the researchers tracked adverse events and symptom changes throughout treatment and follow-up. Worsening of depression was not reported as a common outcome. The most commonly reported side effects were headache and scalp discomfort, which were mild to moderate and temporary (Cole et al., Am J Psychiatry 2022;179(2):132–141). Individual results may vary.

The trial used standardized mood scales to track symptoms at multiple points during the five-day treatment week and during follow-up. This means the research team was actively monitoring for worsening — and did not flag it as a frequent problem in this study.

That said, the published SAINT® trials are relatively small compared to large multi-center medication trials. Rare effects may not show up until more people have been treated and followed over longer periods. Your psychiatrist can discuss what the current evidence does and does not cover for your individual situation.

For a full breakdown of side effects and risks, see Is SAINT® TMS Safe?.

During the five-day SAINT® week, you receive 10 sessions per day with breaks between sessions. It is normal to feel tired — you are spending most of the day at the clinic. Headache and scalp discomfort are the most common physical side effects and usually ease over the first day or two.

Mood-wise, some people feel better quickly — even within the first day or two. Others do not notice a change until later in the week or after the week ends. A temporary dip in mood, if it happens, is most likely to appear during the week or in the first week or two after treatment.

In the 30 days after SAINT®, the treatment team follows up to track your response. Some people continue to improve. Others level off. A small number may need additional treatment or a different approach. The team checks in so they can tell the difference between a passing dip, a plateau, and a need to adjust the plan.

If at any point your mood drops sharply, you feel hopeless, or you have thoughts of suicide, call your treatment team right away. If you are in crisis, call or text 988. Do not wait for your next scheduled follow-up.

Call your treatment team at 954-827-9793 if you notice any of the following during or after SAINT®:

A sharp drop in mood that does not lift within a day or two. Thoughts of suicide or self-harm. Feeling hopeless or that things will never get better. New symptoms you did not have before treatment. Anxiety that is new or significantly worse. Any change that concerns you.

If you are in crisis or having thoughts of suicide, call or text 988 immediately. The 988 Suicide and Crisis Lifeline is available 24/7, free and confidential. You can also text 988. If you are in immediate danger, call 911.

You do not need to figure out whether what you are feeling is a 'dip' or something more serious. Call and let the clinical team assess it. That is what follow-up is for. Check your eligibility or verify your insurance if you are considering SAINT®.