It has been almost a year since I decided to write up my story on how I came to be injured by transcranial magnetic stimulation (TMS). In all honesty, at that time I was convinced that my injury was some sort of mystery that I would never solve. I could have never known how much I would be able to learn on my own, just having the willingness to search for answers.
In the past year I have spoken to approximately a hundred people injured by TMS, countless doctors, and quite a few medical researchers and scientists. What I was able to learn and put together about the nature of TMS injury and the culture surrounding it yields an incredible insight into the treatment itself and into the nature of the medical model in its current form.
This article is devoted to the analysis of the harm currently being caused by TMS. It is not intended to provide a balanced view of the therapy or its practice.
First, I consider it important to identify the very clear set of symptoms that are emerging in the group of people harmed by TMS. After speaking with and reading the testimony of hundreds of people, the most common symptoms are:
- Significantly worsening depression and anxiety (which may also be newly “treatment-resistant”)
- Cognitive impairment such as short-term memory or functional memory loss and decreased ability to multitask
- Panic attacks
- Increased suicidal ideation
- Chronic headaches
- Loss of balance,
Almost every person I’ve spoken with experienced at least one of these, if not all of them.
Additional symptoms that are somewhat less common include:
- Hearing loss
- Eye injury
- Different forms of tachycardia
- Seizures and epilepsy
- Blood pressure problems
- Speech problems
- Muscle pain/weakness/fasciculations/cramping/tightness
- Environmental sensitivities to temperature, light, smell, and sound
- Sensitivity to medications and supplements
Psychosis has also been observed in a few rare cases, but at least half of those specifically involve overuse of TMS (as described in this article).
It also became obvious to me that these symptoms manifest themselves in a very specific way. For instance, the worsening anxiety and/or depression is unrelenting and does not respond to treatment. As an example, before my TMS injury, when I was extremely anxious or depressed I would run longer and start eating really well, and this would always improve my symptoms to some degree. Typically, the harder I worked out, the better I felt, and the better I ate, the better I felt.
But after TMS, when I became depressed and anxious, exercise and eating did not help. I immediately began working out harder and harder and put myself on a stricter diet, which became stricter because I never got any relief from my symptoms. Every day I woke up feeling the same intense depths of despair, and I would become very anxious during the day. If I tried to meditate or run or use the CBT methods I had developed in the past, none of them made ANY difference at all. I found this to be remarkable and deeply disconcerting, which only compounded my situation.
Another characteristic of my TMS injury was that instead of improving in the months following TMS, I actually got worse. Immediately after TMS, I did not feel nearly as bad as I began to feel as time went on. Immediately after TMS, I still had my depression and anxiety, and I may have even felt slightly better due to the placebo effect and the hope that it was helping me.
However, about a month after TMS, I felt my symptoms were slowly intensifying until, about three months after TMS, they had become far more severe. The level of depression I felt was at least ten times what it was before. Also, instead of having anxiety occasionally bother me, I now had it all day, and panic attacks that I had only experienced once or twice in my whole life became a daily occurrence.
I concluded that this is what led to the subsequent increased, intense suicidal ideation that I experienced, which is what most others have mentioned to me when discussing their TMS injury as well. When you are extremely depressed and frequently panicking, suicidal ideation naturally follows; you come to believe you will never get any relief from the suffering and you begin to doubt if you can live with it.
To me, this is a normal human response to the trauma that TMS causes in the brain and on the nervous system. If we take a step back here and look at how these symptoms are manifesting, we can see this is “delayed onset.” New symptoms are continually manifesting after the initial injury has occurred.
This happens with most of the other symptoms as well. I developed constant muscle fasciculations in my legs about three to six months after TMS. These were part of a larger muscular issue that began developing a few months after treatment: cramps, burning, numbness, and tingling in my legs, as well as sciatica. The symptoms slowly evolved over that period into what I am experiencing at present.
TMS appears to create a dysregulation of electrolytes in the body. I believe it to be sodium ion channelopathy acquired from the electrical injury. While this may be controversial, it is my suspicion that it is what is causing the muscle spasms along with the pain, numbness, weakness and tingling. While those symptoms are very common, we are seeing also some less common symptoms that appear to be a more severe form of this condition.
For instance, I am aware of people who have had episodes of syncope from hyponatremia after drinking too much water due to excess thirst or at the direction of their physicians because of muscle cramping. They have also experienced trouble breathing.
Before TMS, I would occasionally become dehydrated after paying too little attention to my water intake for a week or two. Now, if I drink less than 80 oz of water in a day, I will experience serious dehydration, intense muscle cramping, and increased cognitive impairment the following day.
Additionally, it appears that people are experiencing more instances of tinnitus when they had hearing protection properly in place for the duration of the TMS treatments than those that did not have hearing protection at the time of injury. This seems to suggest that the tinnitus is being caused by damage to the auditory cortex and not from external sounds. In fact, TMS treatment did not seem excessively loud to me or to others, although I do know that loud, repetitive noises can cause hearing loss. The auditory cortex of the brain is located close to the typical treatment site in TMS.
As I began to experience these symptoms and struggle to understand the reason, I began to think about similarities with each person I was speaking to. They all told me the details of their experience with TMS and, typically, any theories they had about medical injury—specifically (and most often) psychiatric injury.
This led me to an interesting discovery. I began reading about the injuries that occurred with electroconvulsive therapy (ECT). My mind was almost instantly blown. I had been searching for a very long time to find some sort of cohesive explanation, a similarity to another type of injury or pattern that would give me some insight into what had happened to me. What I saw with ECT was that the types of injuries, the symptomology and the general fallout was very similar—almost exact.
Both injuries showed signs of traumatic/chronic brain injury, cognitive impairment, and neuromuscular and central nervous system (CNS) problems/agitation. I began searching the literature and found a community that was well-read in the evidence of the damage caused by ECT and the nature of diffuse electrical injury.
I realized it is important to understand not just the physiology of the damage caused by the injury, but also the kind of recovery people injured by TMS might expect.
The first important piece I read was an article by Jennifer Berg and Michael Morse. It is incredibly important because it describes both the diffuse electrical injury symptomatology and the difficulty some doctors have in addressing it because of the subjectivity of the symptoms. It describes the reasons for delayed onset of symptoms and damage, the psychological and physiological symptoms, and why the injury so rarely shows up on imaging and other diagnostics.
In summation, this article validates the theory of electrical injury and the difficulty doctors have verifying it. It is extremely important to point out that the problems with diagnosing and treating this injury are not the lack of evidence of injury but that doctors simply are not diligent enough in seeking the right conclusions to diagnose the injury.
The next important step is tying this electrical shock injury to TMS injury. You may think that since TMS does not use direct electrical current it is not shocking the brain or inducing electrical current into the brain, but that is not correct.
In fact, according to the manufacturer’s websites, you will typically find a statement that TMS is not the same as ECT. While this is true, it does not mean that TMS does not shock the brain and cause the same type of electrical trauma that ECT does. I think the fact that manufacturers overtly deny being an ECT treatment is very telling. TMS is obviously not ECT, just as it is obviously not an SSRI or talk therapy treatment. But unlike those, it does induce electricity into the brain.
I think the direct statement of difference is to try and diffuse an inherent connection people may make about having their brains shocked, the associated discomfort and obvious risks of such a treatment. TMS treatment is considered “benign” because it is less invasive (and less dramatic), but it is not.
Expert evidence presented in recent ECT litigation by Kenneth Castleman demonstrates that ECT causes damage by both heat and electroporation (that is, tearing holes in individual cell membranes so that they fail and cause cell death). Both heat and electroporation are generated by rapidly alternating electrical fields and are not exclusive to the physical manifestation of the electrical current itself. With TMS, electrical current is still being generated inside the skull by means of electromagnetic induction, as well.
Therefore, the same damage and impact on the brain is being exerted by the electromagnetic coil used in TMS. If you Google how TMS works, you will get the same answer: it works by generating rapidly alternating electrical fields, which we now know generate both heat and electroporation inside the human skull. In this way it is similar to ECT, simply without the direct electrical current applied to the temples. One could even say it is an evolution of ECT.
As if these similarities with ECT were not enough, we learn something else from the Castleman document: ECT practitioners go through a process of initially determining a patient’s seizure threshold. Clinicians have a testing session where they shock their patients with varying levels of electrical current to see what level of current is required to induce a seizure in the patient. After they have this data, they can produce a seizure at the lowest level of electrical current needed to avoid additional electrical damage to the patient.
In TMS, every patient is given an initial session where the clinician measures or maps the patients “motor threshold.” The patient is hooked up to the TMS machine and the clinician activates the machine and directs it at different parts of the brain to see if the patient’s hand twitches or not. To my knowledge, this is done so that the treatment will not induce a seizure.
However, the clinician has to specifically manipulate the machine to avoid inducing a seizure the way ECT does. This is further evidence that TMS is generating an electrical current inside the brain in a strikingly similar manner to ECT, and that it uses a similar methodology to measure its effects on a patient.
To understand the dangers of TMS, we need to understand the basics of the energy it uses. Electromagnetic waves such as the ones created by TMS are made up of two simultaneous types of energy: magnetic and electric—hence the term electromagnetic wave or field.
TMS devices generate a minimum of a 1 to 1.5 tesla electromagnetic field. The electrical component of the field generated, based on this energy conversion table, is up to 797,700 to 1,196,550 milliamperes (mA) per square millimeter. In a study by Leo Alexander and Hans Löwenbach on specific damage done by ECT, they found that just 20 mA per square millimeter of brain tissue would cause irreversible damage to the tissue. TMS is far beyond the threshold established by the study.
The magnetic component of the field generates up to 10,000 to 15,000 gauss. The earth naturally generates a magnetic field of about .25 to .65 gauss, and the generally accepted safe occupational levels of gauss are generally set at 5 to 10 gauss. That means TMS could be generating anywhere from 1,000 to 1,500 times the amount of magnetic energy that is generally considered safe.
While electromagnetic fields do dissipate the further you are away from them, in TMS the coil is often held just millimeters away from the patient’s skull. This is causing damage to patients’ brains, and while the brain is a resilient organ, we cannot expect it to mitigate damage from that amount of force. The question is not why people are harmed by TMS but, rather, how is it that some are not harmed by TMS.
Those Who Were Not Harmed
I have spoken to quite a few people who were not harmed, but claim they were helped by TMS therapy. One such person told me they felt better after TMS treatment and were not harmed in any way.
When I asked further questions about how long they felt good and if they still felt better today, they replied that the positive effect had lasted for a few months after their last treatment, but they slowly reverted back to their previous state. They also told me they were currently battling some significant depression and a bit of anxiety. That was very interesting but, sadly, not a surprise.
The surprise came next, when I asked if they had any suspicion of being harmed by TMS. They said they did not feel they had been harmed in any way. I then asked if they were sure and I listed all of the aforementioned symptoms associated with TMS and electrical injury. This is where things became very interesting: a few months after TMS, this person had a severe and long-lasting bout of sciatica with no apparent physiological cause. That is, this person had never had sciatica before and they found no explanation for the occurrence.
I asked some probing questions about how the sciatica could have come on and they simply had no explanation. This opened up a discussion about the sensations experienced during TMS, particularly the “dip” in which the patient becomes more depressed during TMS and then has to stick with treatment in order to come out of the dip. This person had experienced such a dip and had concerns about their health during treatment. They expressed a tremendous amount of concern and emotional discomfort in association with their treatment when speaking about it with me as well.
Coming away from this interview, both of us felt that maybe TMS was not as beneficial as they had originally thought. In fact, the conversation raised a few new concerns. This depressive dip that occurs during TMS could be a neurological response to acute brain trauma. Furthermore, ignoring that dip causes so much trauma within the brain that the patient begins to experience anosognosia—becoming unaware of their condition because they are in a kind of shock and no longer possess the faculties to properly understand their condition.
I experienced this same thing. I was having so much cognitive dysfunction I could no longer recognize the disoriented state TMS had induced in me. Additionally, I think the delayed onset of symptoms is due to a similar phenomenon. The nervous system is in a dysfunctional state for several months after the injury caused by TMS.
When it starts to recover, it now has injuries and impairments to its ability to function, and we see the long-term symptoms begin to emerge—such as the sciatica in this case. In other cases, such as mine, we see a more severe set of symptoms, such as cognitive impairment and neuromuscular issues. It is also possible that cognitive impairment accounts for some of the indifference to and lack of reporting of serious side effects. Physicians are often well aware of this possibility and choose to ignore it in many cases.
For those who follow TMS testimony closely, a typical objection to the existence of injuries is “What about all the people it has helped?” The truth of the matter is that we see the same thing with ECT. People claim real relief from the treatment, and it does have some amount of temporary efficacy.
This may occur because electricity always follows the path of least resistance. Everyone’s brain physiology and the variables involved in the treatment are different. Also, the brain is made up of at least seventy percent water, so the electrical current and fields generated inside the brain will follow a different path every time. This means that while one treatment could prove harmless, the next one could have devastating effects.
We see the same variability with lightning strikes. While one person can walk away perfectly fine, the next will be killed instantly or have severe neurological problems like we see in TMS or ECT. There is actually a very interesting article on its effects on a group of children that also corresponds to what we see in ECT and TMS.
Another trend I am now seeing is that, as with ECT, people who were at first successful with TMS are going back for subsequent treatments when the benefits wear off. They will have a relapse of symptoms and then become injured in subsequent treatments. I fear patients undergoing TMS will be pulled into the same debilitating loop as those given ECT.
The initial treatment may prove beneficial, but its efficacy will fade, as the therapeutic effect seems to be simply some kind of endocrine response to the trauma itself. Traumatic injury causes the body to release hormones that promote healing and reduce pain. But subsequent TMS treatments will lead to additional sensitization of the CNS to electrical injury, inevitably causing serious, life-altering harm to the patient.
As if all the aforementioned problems with TMS were not enough, I have seen another pattern emerge from the people I have spoken with. Many of the clinics administering TMS know very little about the treatment, the science of its effects, and even less about the brain, CNS, and human body. The staff is made up of trained technicians, not educated scientists.
The person who administered my treatments was newly trained and had no other medical training or knowledge. Their only knowledge of TMS was given to them by the manufacturer’s training personnel shortly before my visit. I did not learn of this until well after my treatments had started.
Furthermore, during my treatments, the intensity of the machine was increased, creating a more intense feeling of drunkenness, lightheadedness, and impairment. When I described this to my technician and her manager, they both told me that they had to increase the intensity to reach the therapeutic effect. At this point, I was so desperate to make it work, I agreed. They did not know why, but they had been taught to do this.
Day after day, I made the same complaint, and they said it was “normal.” When I pressed them about it, they specifically told me that the manufacturer instructed them in training to turn up the intensity of the treatment regardless of patient complaints. The manufacturer told them to ignore patient complaints and turn up the intensity because there was “no chance of harm” during the process.
At this point, given all I have learned, experienced, and witnessed about TMS, I would disagree with that. It is bad enough that this happened to me, but worse knowing that those who came after me into that TMS clinic have experienced the same thing. I heard the same story from people injured by TMS all over the US, Canada, the UK, Australia, New Zealand, and Singapore—virtually all over the world.
Another disturbing pattern I identified was the use of TMS for off-label use. One gentleman I spoke with described severe anxiety, insomnia, and several other life altering problems after just one treatment. He could no longer work. He told me he was administered TMS for Irritable Bowel Syndrome (IBS).
I was in disbelief. I said, “Do you have any history of mental health issues?” He said, “No, never.” He had a very severe reaction to TMS; he could barely stand still and his voice was racing and disjointed—obviously in rough condition. In his case the treatment was much worse that the disease.
This was not the only such story I heard. People have described TMS being used to treat their addiction problems, dementia, Alzheimer’s disease, pain, or to simply “to improve brain function” as well. The cases of Alzheimer’s and dementia are particularly troubling because these patients were already suffering from cognitive impairment. We risk making things much worse for patients who may not possess the awareness or ability to report further harms.
I have also heard from many people that they had relatively minor anxiety or depression and were asked by the office staff to exaggerate their responses to the PHQ-9 questionnaire so that TMS would be approved by insurance. People who go in for TMS are usually desperate for help and have been convinced that this is a no-risk miracle cure. This is a massive contributor to both these clinics’ bank accounts and to inappropriate levels of risk and harm to their patients.
All of this has a huge impact on a person’s physical and emotional health for many reasons. So, what happens when they go to a doctor for help with the harm done? Typically, and almost exclusively, the patient is invalidated, with doctors denying the possibility of any harm having been done to them from this treatment. This is simply because these experiences are not listed as a side effect in the common literature or on the manufacturer’s website.
This is a fierce, fierce tragedy. Not only is someone harmed seriously despite being told they wouldn’t be, but now all the physicians they see deny the harm and sometimes even try to add an additional mental illness to their diagnosis simply because they were harmed by TMS.
It does not help that there is so little knowledge out there about electrical injuries. Once I learned that the injury is electrical in nature, I asked my doctors about it, but they had no insight nor any inclination to try to treat that type of injury, which is “outside their specialty.”
Interestingly enough, after I had queried all the usual medical resources, I called a large and reputable electrical injury rehabilitation institute and described my injury to them without using the word TMS. Instead, I told them that I had my head next to a 1 to 1.5 tesla electromagnetic coil for 20 minutes a day for two months—after which they replied that they do commonly treat those types of injuries and they gave me the rundown on what they did and how much it would cost, which would not be covered by my insurance.
I found this to be very interesting. Once the buzzword “TMS” was removed from the situation, physicians told me several times, and in subsequent follow up emails, that this is indeed an injury they could attempt to rehabilitate me from.
As for the injury itself, the next problematic point is that it is very difficult to show brain injuries diagnostically. TMS is no different. Electroporation affects each cell individually as it expands and contracts the cell walls; therefore, each cell has its tipping point where it cannot recover its form and fails altogether, causing cell death. That, combined with the fact that the current and electromagnetic fields being generated fluctuate based on the conductivity of the matter they are interacting with, means there is no way to predict which cells will be affected and which will not.
So, what we have is microscopic damage taking place throughout different, very small, particular areas of the brain which will not show on any kind of imaging test like an MRI, CT, or PET scan. I had several myself and have talked to countless others that have had the same, and so far we cannot see, nor have our technicians’ reports shown, any damage.
This makes it that much harder for doctors to believe their patients—although they do not have any reason to disbelieve them, either. It is very important to be aware that these scans also do not show damage caused by other means—even those which are now well-established—such as the brain damaging effects of psychiatric medications or chronic traumatic encephalopathy (brain damage caused by repetitive head injuries, typically in professional sports players).
These diagnostic techniques simply do not work as well in this area, even though there is very clearly significant damage to the brain’s function. In order for patients harmed by TMS to even begin to hope to recover, generally speaking, physicians need to start by acknowledging the injury. This is unlikely, however, due to the professional and financial pressure they are under to defend its highly profitable industry.
I do believe recovery is possible. Because of the way TMS injures the CNS, I believe that CNS sensitization is the primary issue to recover from. When our systems are overwhelmed enough or we come into contact with stimuli to which we are particularly sensitive, we experience panic attacks or sometimes other catastrophic symptoms like tachycardia, syncope, or seizures. On top of this our general sensitivity to anxiety and depression seems to be heightened.
So far, the best approach I have found is to provide as much of a neutral environment for the CNS to recover as possible. This means, psychologically, as little stress and negativity as possible. This will give the CNS a safe space to repair itself and use whatever bandwidth it has freed up for that. I have also found diet to be essential: I really only eat organic food with no preservatives. Essentially, I eat like our ancestors do: primarily organic and free-range vegetables, fruit, fish, and poultry.
Healthy activity is incredibly important to keep our bodies functioning optimally. I shoot for at least 45 minutes of cardio per day. For some people, that is not realistic and they have to start small—there is nothing wrong with that and it is actually the right move. Just keep active and engaged in your physical environment in ways that are not overly strenuous.
If we keep ourselves in a stimuli-neutral environment we can then introduce things that will help the brain recover cognitively as well. Playing games, listening to positive music, doing puzzles of all different kinds (like Legos, crosswords, etc.), and engaging in artwork to stimulate brain activity and create new neural networks that can build around our injuries and compensate for our losses.
It is key to focus on experiences you see as positive. Positive experiences are the building blocks of healthy brain activity and healing. This approach is the long-haul approach and with time, I think real recovery is possible and there is very little risk involved.
Recovering from injury caused by TMS demands respect and a healthy attitude toward healing just like all mental health challenges do. We cannot expect to solve these problems with more medications and therapies that have significant risks just so we can live the unhealthy lives that may be expected of us. It is time to focus on being human again, accepting and embracing the reality that comes with that, with all of our hearts and minds.
Lastly, I would like to express my sincere thanks to Sarah Price Hancock who has offered her indispensable brilliance in my endeavors to understand my injury and everything that comes with it.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.