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Transcranial Magnetic Stimulation (TMS) for Schizophrenia

Medically Reviewed by Jennifer Casarella, MD on May 16, 2022

The main way doctors treat schizophrenia is with medicines. Antipsychotic medicines, usually taken every day, can make your hallucinations, delusions, or other disordered thoughts less intense and less frequent. But not everyone responds to these medicines in the same way. Even if medicine helps, you might still have symptoms. Medicines often don’t help as much with negative schizophrenia symptoms, including apathy or withdrawal from social life. That’s why researchers have looked to other methods of treatment like the painless procedure called transcranial magnetic stimulation (TMS) to be used along with medicines to help with schizophrenia in different ways.

Does it work? The short answer is maybe. There’s some evidence it might help with certain schizophrenia symptoms, but the data so far is too limited to know if it really works or how well. Using TMS to treat schizophrenia or certain schizophrenia symptoms isn’t proven or approved. Clinics or doctors shouldn’t make any promises or claims that TMS will treat your schizophrenia.

How Does Transcranial Magnetic Stimulation (TMS) Work?

A TMS device has one or two copper coils. It can be placed against your head over different parts of your brain to deliver brief magnetic pulses to your scalp. The strong magnetic pulses form a mild electric current in the outer surface of your brain. It shouldn’t hurt. That current affects activity in your brain cells or neurons. It’s not clear exactly how it works, but it may change the way your brain cells communicate or “talk” to each other, helping with your symptoms.

TMS has been approved for major depression, migraine pain, and obsessive-compulsive disorder (OCD).

How Effective Is Transcranial Magnetic Stimulation (TMS) for Schizophrenia Symptoms?

At this point, no one really knows if TMS is effective for schizophrenia. Studies are limited and results are mixed. While there have been a number of studies – some of them looking encouraging – the studies that have been done have been small. There are other issues that make it hard to tell if TMS really helps or not. For every study that suggests it might work, there are others that show it doesn’t. More and bigger studies are needed to figure this out.

One report looked at 41 studies testing TMS, delivered to two different parts of the brain, for people with schizophrenia. Overall, the report said that the evidence for TMS in schizophrenia wasn’t strong enough.

But several studies do suggest that TMS might help with hearing voices (auditory hallucinations) or apathy. A review of evidence for TMS in schizophrenia over 15 years said that it appears to be safe. It found that it can help with certain symptoms, especially auditory hallucinations in some studies. But not all studies have found that it works. About 20% of people with schizophrenia hear voices even when they take their medicine, so the authors said it’s worth investigating with more studies to see if TMS could help.

One report looked at 21 studies of TMS for auditory hallucinations in schizophrenia. It found that the placebo effect can be a big source of bias in studies testing TMS. The placebo effect is improvement with treatment that happens not because it really works but because you believe it will help. So if you were to get TMS in a trial or otherwise, it’s possible you could think that it works even if it doesn’t.

A more recent review came to a similar conclusion. It looked at 30 small studies on TMS for hearing voices in schizophrenia. They found 12 studies that suggest it might work, but another 18 that didn’t show evidence it helped.

The bottom line is that the evidence is mixed, and the studies are too small and not consistent enough to be sure. Even if it does work, it’s not clear how TMS should be given to help with schizophrenia. There aren’t many studies that have looked at whether TMS helps with some other symptoms, like delusions or disordered thinking, either.

Could TMS Help With Negative Symptoms of Schizophrenia?

It’s possible. That’s important because unlike positive symptoms such as delusions and hallucinations, negative symptoms such as apathy don’t respond as much to approved medicines. People who mainly have negative symptoms of schizophrenia often don’t do as well. One review looked at 57 studies including a total of more than 2,500 people testing TMS for negative symptoms of schizophrenia. When you put all the evidence together, it looks like TMS might help with these otherwise hard-to-treat schizophrenia symptoms. But the results are still mixed and might be biased. Even if it works, it’s still not clear how best to give TMS for these schizophrenia symptoms.

One recent study found evidence that the lack of motivation, expression, and inability to enjoy things that people with schizophrenia sometimes have comes from a breakdown in the connections between two parts of the brain. In 11 people, they tried to restore those connections with TMS twice a day for 5 days. The study was small and brief but suggested that TMS might help.

So again, there are lots of studies and TMS does look promising for certain schizophrenia symptoms that don’t go away with medicines. But it’s too soon to say it works until bigger and better studies are done. For now, doctors don’t have enough information to recommend it, and TMS isn’t approved for schizophrenia or any of its symptoms.

What to Know Before Trying Transcranial Magnetic Stimulation (TMS)

If you decide to try TMS despite the uncertainty, it’s often given in a doctor’s office. It isn’t always given in exactly the same way. The stimulation can be more or less intense. It may differ in length. Doctors also can use it to stimulate different parts of your brain. These differences in how TMS is given is part of why it’s hard to tell if it works for schizophrenia. Different studies testing TMS have used it in different ways, which makes it harder to compare what they’ve found.

Before treatment, you have to remove anything magnetic you’re wearing or carrying. You’ll wear earplugs because TMS machines make loud clicking sounds. You’ll feel a tapping sensation, but it usually shouldn’t hurt. For other conditions TMS is approved for, such as depression, it involves a series of treatments. Each session lasts about 30 to 40 minutes. You might have it every weekday for a period of 4 to 6 weeks, depending on how you do.

You don’t need anesthesia or other medicine. After TMS, people can usually go about their day as usual. It has few side effects, but it might cause a headache, painful feelings on your scalp, or twitching in your face. Since TMS isn’t approved for schizophrenia, there isn’t a set protocol for this use. Any use of TMS for schizophrenia would be “off-label.” Doctors generally can use approved drugs or treatments for uses that they aren’t approved for. But it’s a good idea to ask questions any time this possibility comes up to make sure you want to try it.

Who Shouldn’t Get Transcranial Magnetic Stimulation (TMS)?

TMS is safe for most people. There is a slight risk of seizures that happens in less than 1% of people. Fillings or braces on your teeth are OK, but you can’t get TMS if you have any other metal in your head. If you do, that could lead to serious injury or death. Don’t get TMS if you have:

  • Aneurysm clips or coils
  • Stents in your neck or head
  • Electrodes monitoring brain activity
  • Metallic implants in your eyes or ears
  • Shrapnel or bullet fragments in your head
  • Facial tattoos that are metallic or sensitive to magnets
  • Any other metal in or near your head

It’s important that your doctor know about any medical conditions you have, including any history of seizures and mental health conditions. Otherwise, if you or a loved one has schizophrenia and symptoms that aren’t responding to treatment, talk to your doctor about what they’d recommend.

Show Sources

SOURCES:

National Institute of Mental Health: “Schizophrenia.”

Schizophrenia: “The efficacy of transcranial magnetic stimulation (TMS) for negative symptoms in schizophrenia: a systematic review and meta-analysis.”

Cochrane Database of Systematic Reviews: “Transcranial magnetic stimulation (TMS) for schizophrenia.”

Food and Drug Administration: “FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder,” “Understanding Unapproved Use of Approved Drugs "Off Label".”

National Alliance on Mental Illness: “ECT, TMS and Other Brain Stimulation Therapies.”

Brain Stimulation: “Off-Label Promotion of Transcranial Magnetic Stimulation on Provider Websites.”

Neurology of Systemic Diseases: “Transcranial Magnetic Stimulation as Treatment in Multiple Neurologic Conditions.”

Johns Hopkins Medicine: “Frequently Asked Questions About TMS.”

Neuropsychobiology: “Transcranial Magnetic Stimulation for Positive Symptoms in Schizophrenia: A Systematic Review.”

Schizophrenia Bulletin: “Placebo Response in Repetitive Transcranial Magnetic Stimulation Trials of Treatment of Auditory Hallucinations in Schizophrenia: A Meta-Analysis.”

National Center for Complementary and Integrative Health: “Placebo Effect.”

Innovations in Clinical Neuroscience: “Efficacy of Transcranial Magnetic Stimulation (TMS) in the Treatment of Schizophrenia: A Review of the Literature to Date.”

American Journal of Psychiatry: “Cerebellar-Prefrontal Network Connectivity and Negative Symptoms in Schizophrenia.”

Neuropsychiatric Disease and Treatment: “Transcranial Magnetic Stimulation (TMS) Safety with Respect to Seizures: A Literature Review.”

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