By Dr. David Woo - September 6, 2018

Transcranial magnetic stimulation (TMS) is a non-invasive, non-systemic treatment that uses magnetic fields to treat major depressive disorder. It has been shown to provide successful relief from symptoms of treatment-resistant depression when other treatments, like antidepressants and talk therapy, have not shown significant or consistent results.(1,2,3)

Some people may feel apprehensive about leaving their prescription antidepressant behind during the 6-week TMS treatment, even if the antidepressant has stopped working. If this describes you, you may be wondering, can TMS treatment be done while on antidepressants? The short answer is yes. But let’s dive into what a drug-device interaction is and learn why some patients may benefit from a treatment that involves both TMS and certain prescription antidepressant medications.

What Is a Device-Drug Interaction?

A drug interaction is an interaction between a prescription medication and another substance, like a certain food, supplement, or other medication — or between a medication and a device, like a pacemaker. Drug interactions can change the way a medication interacts with your body and can cause:

• The medication to become less effective
• The medication to become more active or potent
• Adverse side effects that can affect your health (4)

A device-drug interaction is an interaction that occurs between a prescription medication and a medical device. In the case of TMS and antidepressant medication, the device is the TMS treatment technology.

TMS May Be Considered an Augmentative Therapy With Certain Prescription Antidepressant Medications

An augmentative therapy is when two different treatments are combined to increase, or augment, the effects of the first treatment.(5) TMS can sometimes be used to augment the effects of a prescription antidepressant.

A report published in BMC Psychiatry in 2014 analyzed seven randomized clinical trials involving sham (placebo) augmentative TMS treatment and active TMS augmentative therapy. All participants in the studies included in the analysis had previously taken a course of antidepressant medication and did not show improvement in their symptoms. During these trials, TMS treatment was used as an augmentative therapy to antidepressant medication, either simultaneously (during TMS treatment) or in combination with TMS treatment (taken before and after TMS treatment, but suspended during the course of TMS treatment). Researchers compared patients who received active TMS treatment versus sham TMS treatment.

The analysis concluded that augmentative active TMS therapy significantly increased the effects of the antidepressant medication, compared to sham TMS treatment. Additionally, the report stated that there was not a significant difference between patients who received active TMS treatment and patients who received sham TMS treatment in terms of side effects or drop out rates that may have been due to side effects. This suggests that augmentative TMS may be an effective and safe option for the treatment of treatment-resistant depression.(6)

Furthermore, another study published in 2005 in the journal Psychiatry reported findings that demonstrated a significant accelerated impact on the effects of an antidepressant called amitriptyline while undergoing TMS treatment. Over the course of four weeks, patients were given either sham or active TMS treatment, in addition to taking amitriptyline.

Researchers compared patients’ Hamilton Depression Rating Scale scores after one week of treatment to those taken before starting treatment. During the first week, there was a larger reduction in the scores of the Hamilton Depression Rating Scale for patients who received active TMS treatment while taking amitriptyline than for patients who received sham TMS treatment while taking amitriptyline. A reduction in scores after one week of treatment indicates a lower level of severity of depression, and therefore patients improved more quickly with medication plus TMS than with just medication.(7,8)You can learn more about TMS therapy success rates here.

In What Situations Might TMS Be Combined With an Antidepressant Medication?

Augmentative TMS treatment with a prescription antidepressant may be applied when patients show initial improvement while taking an antidepressant, but for some reason, stop seeing results. However, although augmentative TMS therapy has been safely administered with antidepressant medications, certain antidepressants — specifically tricyclic antidepressants — can increase the risk of seizure when taken during TMS treatment.(9)

A treatment consisting of both TMS treatment and an antidepressant prescription is administered under strict supervision by your doctor. This means that patients undergoing TMS therapy while taking a prescription antidepressant medication are closely monitored and evaluated throughout the treatment to ensure their safety. Medical supervision significantly minimizes the risk of adverse reactions.

At Madison Avenue TMS & Psychiatry, your safety and well-being is paramount. We carefully examine your health history to create a personalized treatment plan that works best for you. Throughout treatment, our doctors regularly monitor the health of each patient to ensure optimal results while maintaining excellent health.

Types of Antidepressants

Antidepressants are medications that increase levels of certain neurotransmitters (molecules that help brain cells communicate with each other) associated with depression. There are many different classes of antidepressants, each one classified according to which neurotransmitters it affects:

• Selective serotonin reuptake inhibitors (SSRIs) – serotonin
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) – serotonin and norepinephrine 
• Tricyclic antidepressants (TCAs) – serotonin and norepinephrine
• Noradrenergic and specific serotonergic antidepressants (NaSSAs) – monoamines including dopamine, norepinephrine, and serotonin
• Monoamine oxidase inhibitors (MAOIs) – norepinephrine, serotonin, and dopamine

Learn more about the different classes of antidepressants, here. 

The most effective depression medication for one person may not be an effective antidepressant for someone else. Oftentimes, a patient may need to try more than one depression medication before finding the right one.

Talk to Your Doctor About Whether TMS Treatment is Right for You

Your doctor at Madison Avenue TMS & Psychiatry will determine if TMS treatment combined with a certain prescription antidepressant is right for you. Treatment decisions are determined based on each patient’s specific patient history in addition to his/her current health. Learn more about insurance coverage and TMS therapy costs here.

Resources

1. Avery DH, Isenberg KE, Sampson SM, et al. Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial. J. Clin Psychiatry. 2008; 69:441-451. Link. Accessed August 22, 2018
2. Carpenter, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety. 2012 Jul;29(7):587-96. Link. Accessed August 22, 2018.
3. Grohol JM. TMS Treatment for Depression Gains FDA Approval. Psychcentral.com.  Updated October 9, 2008. Accessed August 22, 2018.
4. Drug Interactions: What You Should Know. U.S. Food & Drug Administration. Link. Updated September 25, 2013. Accessed August 22, 2018.
5. Augmentation strategies for depression. Harvard Mental Health Letter. Link. Published December 2010. Accessed August 22, 2018.
6. L Bangshan, Zhang Y, Zhang L, and Li L. Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study. BMC Psychiatry. 2014; 14: 342. Link. Accessed August 22, 2018.
7. Rumi DO, Gattaz WF, Rigonatti SP, Rosa MA, Fregni F, Rosa MO, Mansur C, Myczkowski ML, Moreno RA, Marcolin MA. Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study. Biol Psychiatry. 2005 Jan 15;57(2):162-6. Link. Accessed August 22, 2018.
8. Hamilton Depression Rating Scale. The National Palliative Care Research Center. Link. Accessed August 22, 2018.
9. NeuroStar Prescribing Information. NeuroStar. Page 8. Link. Publication date unknown. Accessed August 22, 2018.

Dr. David Woo

Dr. Woo has been seeing patients in private practice since 2002, always with the goals of combining evidence-based medicine with psychodynamic psychotherapy and collaborating with other mental health professionals to ensure the best possible outcomes for his patients. He has been certified to administer TMS at his practice since 2017. His greatest clinical interests include helping patients suffering from depression, anxiety, and obsessive compulsive disorder.