Schizophrenia is mostly treated with antipsychotic medications that help reduce the frequency and intensity of hallucinations, delusions, and disordered thinking. But for some people, medication alone isn’t enough. Negative symptoms of schizophrenia – like social withdrawal, lack of motivation, and difficulty expressing emotions – are difficult to treat with medications and can persist even with treatment.
For that reason, researchers are often exploring alternative methods of treatment. One such treatment is Transcranial Magnetic Stimulation (TMS) therapy, which can be used alongside medications to help relieve certain symptoms of schizophrenia. While research into TMS is still ongoing, some studies suggest it may help when used alongside traditional treatments.
In this article, we’ll share what you need to know about TMS for schizophrenia, including how it works, what the research shows so far, and things to be aware of when considering this treatment.
What is schizophrenia?
Schizophrenia is a chronic mental health condition that affects how a person thinks, feels, and behaves. It can cause a range of symptoms, including hallucinations (hearing voices or seeing things that aren’t there), delusions (strong beliefs that aren’t based in reality), and disorganized thinking or speech. These symptoms can make it difficult to distinguish between what’s real and what isn’t, leading to significant challenges in daily life.
Although schizophrenia is a lifelong condition, treatment can help manage symptoms. A combination of antipsychotic medication, therapy, and support services can improve quality of life and help patients lead more fulfilling lives. However, early intervention is key – research shows that untreated psychosis can lead to more severe symptoms, frequent hospitalizations, and long-term cognitive and social difficulties.
There’s still a lot to learn about schizophrenia, but ongoing research into brain function, genetics, and new treatment approaches is helping to improve care. While there’s no cure, advances in therapy – including safe, non-invasive options like TMS – offer hope for better symptom management.
Schizophrenia symptoms
Schizophrenia affects how a person thinks, feels, and behaves, making it difficult to distinguish between reality and delusions. Symptoms typically appear in adolescence or early adulthood and can vary in severity. They typically fall into three main categories:
Positive symptoms
Positive symptoms involve experiences that aren’t typically present in healthy individuals. These include:
- Hallucinations: Hearing voices or seeing things that aren’t there
- Delusions: False beliefs, like thinking you have special powers or are being persecuted
- Disorganized thinking or speech: Trouble organizing thoughts, which leads to jumbled or off-topic sentences that are difficult to understand.
Negative symptoms
Negative symptoms refers to a loss of normal functioning. They can include a lack of motivation, difficulty expressing emotions, or social withdrawal. People with schizophrenia may struggle with daily activities and show little interest in work, relationships, or self-care.
Disorganized symptoms
Disorganized symptoms involve difficulties with logical thinking and behavior. For example, a person’s speech may be jumbled or incoherent, movements may be unusual, and behavior might be erratic or inappropriate for the situation.
Schizophrenia or schizoaffective disorder?
These two conditions share many symptoms, however schizoaffective disorder has a mood component which can involve mania or depression.
Schizophrenia treatment options
There is no cure for schizophrenia, and the condition requires lifelong treatment even though symptoms can come and go. In most cases, a combination of medication, therapy, and support can help people manage their symptoms and lead fulfilling lives. In severe cases, hospitalization may be necessary to stabilize a person during a crisis.
Medication
Antipsychotic medications are the primary treatment for schizophrenia. These work by influencing neurotransmitters, like dopamine and serotonin, to help control symptoms.
The exact type of antipsychotic, combination, or dosage will be different for each individual, and a mental health provider will guide patients towards finding the most effective medication with minimal side effects. The goal is to achieve relief with the lowest possible dose necessary. In some cases, additional medications like antidepressants, mood stabilizers, or anti-anxiety drugs may also be prescribed.
Different types of antipsychotics include:
- Second-generation (atypical) antipsychotics: These are newer medications with fewer movement-related side effects than first-generation drugs. They include aripiprazole (Abilify), asenapine (Saphris), and quetiapine (Seroquel).
- First-generation (typical) antipsychotics: These older medications may have stronger side effects, such as involuntary muscle movements. They include chlorpromazine (Thorazine), fluphenazine (Prolixin), and haloperidol (Haldol).
- Long-acting injectable antipsychotics: Some antipsychotics are available as injections given every few weeks. These include aripiprazole (Abilify Maintena) and fluphenazine decanoate.
Psychosocial interventions
Psychosocial treatments can help individuals develop coping skills, improve social interactions, and maintain stability. These might include:
- Talk therapy: Cognitive behavioral therapy (CBT) and other forms of talk therapy can help people manage stress, recognize early warning signs of relapse, and develop healthy thinking patterns.
- Social skills training: This focuses on improving communication, relationship-building, and daily functioning skills.
- Family therapy: This involves providing education and support for families to help create a stable and understanding home environment for people with schizophrenia.
Electroconvulsive therapy (ECT)
ECT may be considered for those who don’t respond well to medication. This procedure involves delivering small electric currents to the brain while under anesthesia, inducing a brief therapeutic seizure.
While this treatment can have positive results for schizophrenia patients, there are other brain stimulation therapies that are non-invasive and don’t require anesthesia – namely, TMS therapy.
Read More: TMS vs. ECT: Which is better?
What is TMS therapy?
Transcranial Magnetic Stimulation (TMS) therapy is a non-invasive treatment that uses targeted electromagnetic pulses to stimulate specific regions of the brain. During the treatment, a magnetic coil is placed on the scalp and brief, focused pulses are delivered to the brain’s outer layer (known as the cortex). These pulses create a mild electrical current that stimulates brain cells and helps regulate abnormal neural activity.
Although the exact mechanism is still being studied, it’s believed that TMS can change the way brain cells communicate, helping improve symptoms of various neurological and psychological conditions. TMS has already been FDA-approved for treating conditions like major depression, obsessive-compulsive disorder (OCD), migraines, and smoking cessation. It’s also being explored for its potential in managing a range of other conditions, including schizophrenia, post-traumatic stress disorder (PTSD), and fibromyalgia.
TMS therapy offers a promising option for those who may not have found relief with traditional therapies. Because it’s non-invasive, TMS doesn’t require medication, surgery, or injections. This means no sedation or anesthesia is needed and patients can return to normal activities immediately after each session.
TMs is sometimes referred to as repetitive transcranial magnetic stimulation (rTMS) due to the repetitive nature of the pulses administered during treatment.
Can TMS help people with schizophrenia?
TMS’s potential as a treatment for schizophrenia is an area of ongoing research. Several studies have explored its efficacy in treating schizophrenia, however results are mixed and the studies are often small. This can make it difficult to draw firm conclusions – for every study suggesting potential benefits, there are others that show no significant effects.
However, here’s what the research shows so far about TMS for schizophrenia.
Some studies have indicated that TMS may help alleviate certain symptoms, such as auditory hallucinations and apathy (often referred to as a negative symptom of schizophrenia). One review, spanning 15 years of research, found that TMS is a safe and effective means of treating both positive and negative symptoms of schizophrenia, especially auditory hallucinations.
Recent reviews have pointed to some promising trends, especially for those struggling with negative symptoms like lack of motivation and difficulty experiencing pleasure. One study that looked into TMS to improve connections between brain regions involved in motivation found some evidence that it could be effective, although the research was small-scale with only 11 participants.
That said, not all studies have demonstrated the same results. For example, one review of deep transcranial magnetic stimulation (dTMS) found that it didn’t reduce psychotic symptoms but showed potential for improving executive functions. As for now, however, TMS shows promise for negative symptoms of schizophrenia that are otherwise hard to treat with medication.
See: How Successful is TMS Therapy?
What to expect from a TMS session for schizophrenia
If you’re considering TMS therapy for schizophrenia, it can be comforting to know what’s involved. Here’s what to expect from a typical TMS session.
Before the session
TMS doesn’t require any special preparation, but you may be asked to remove any metal objectives like jewelry or glasses with metal frames. This is just a safety precaution to make sure nothing interferes with the magnetic field during treatment.
Once you’re settled into a comfortable chair, your TMS technician will go over any questions you have. TMS therapy uses a device with a magnetic coil inside a nonmagnetic casing. Depending on the type of machine, you might wear a helmet containing the coil or the technician will position the magnet near your head using an adjustable arm.
During the session
Before treatment starts, you’ll be given earplugs or another form of hearing protection. This is because the magnet makes clicking sounds, similar to an MRI machine, which can be loud.
The technician will then position the magnetic coil over a specific area of your head. For your first session, they’ll do a process called ‘brain mapping’, which helps find the right spot and intensity for the magnetic pulses. This ensures the treatment is both effective and comfortable.
When the session begins, you may feel a tapping sensation on your scalp as the pulses activate nerve cells in your brain. The strength of the pulses will gradually increase and you may notice small, involuntarily twitches in your hands or face. This is normal and helps confirm the right level of stimulation.
TMS treatment involves repeated magnetic pulses in a set pattern. You’ll hear clicking sounds as the magnet turns on and off, with occasional pauses in between. A typical session lasts between 30 to 60 minutes.
After the session
TMS doesn’t require any recovery time. You’ll be awake during the entire session and can go back to your daily activities right afterwards, whether that’s home, school, or work. Some people experience mild side effects, like scalp discomfort, but these usually fade away quickly.
Follow-up sessions
TMS therapy typically involves multiple sessions administered over several weeks. Each session will follow the same process, although your technician might adjust settings based on how you respond. The goal is to fine-tune the stimulation to maximize benefits while minimizing any discomfort during the session.
Those who prefer a shorter treatment schedule may want to consider accelerated TMS therapy. This involves administering TMS several times per day over just two weeks, providing faster results while reducing overall treatment time.
Read more about accelerated TMS here: Accelerated TMS vs. Traditional TMS: Which One Makes Sense for You?
Side effects of TMS
TMS is generally well-tolerated, however it can have some side effects just like any other medical treatment. Most side effects are mild and temporary, resolving on their own and disappearing as your body adjusts to the therapy over time.
Common side effects of TMS therapy include:
- Tingling or twitching in facial muscles
- Scalp discomfort or sensitivity
- Mild headaches
- Dizziness or lightheadedness
- Neck pain.
The most serious risk associated with TMS therapy is a seizure, however this is extremely rare with a risk of less than 0.01% per session – or fewer than 1 in 10,000. Providers carefully screen for the risk of seizure before starting treatment to ensure patient safety.
If you have any concerns about TMS side effects, don’t hesitate to contact our team. We’ll be happy to discuss the treatment with you.
See More: TMS Side Effects: All You Need to Know
Who shouldn’t get TMS therapy?
TMS can be a life-changing treatment for many people, but it’s not suitable for everyone. Certain medical conditions and implanted devices can make TMS unsafe or less effective for some people.
Who should avoid TMS therapy?
TMS therapy may not be suitable for you if you:
- Have a history of seizures or epilepsy
- Are pregnant or breastfeeding
- Have had a traumatic brain injury, brain tumor, or other neurological conditions
- Take stimulant medications.
Because TMS uses magnetic pulses, it can interfere with certain metal implants or medical devices in the body. This means you shouldn’t undergo TMS if you have:
- Cochlear implants
- Deep brain simulators
- Aneurysm clips or coils
- Implanted electrodes or stents
- Shrapnel or bullet fragments
- Vagus nerve stimulators.
Dental fillings and braces are completely safe with TMS, so you don’t need to worry about those.
Before undergoing TMS, you’ll have an in-depth consultation with your provider to ensure the treatment is safe and suitable for you.
Keep Reading: Who Qualifies for TMS Therapy? (TMS Requirements)
Explore TMS for schizophrenia
While research on TMS for schizophrenia is still ongoing, some studies suggest it may help with auditory hallucinations and negative symptoms. At BestMind Behavioral Health, we offer TMS therapy as a schizophrenia treatment option for those looking for complementary therapies alongside traditional medications.
If you or a loved one is struggling with schizophrenia symptoms that haven’t responded to medication, TMS could be an option worth exploring. Contact our team today to learn more about this innovative treatment.
