TMS and Medication: How TMS Works With (or Without) Your Current Drugs

Sam Clinch • January 20, 2026

Quick Summary


  • Most psychiatric meds can be continued through TMS, but certain drugs affect seizure risk or response and require review.


  • Careful pre-treatment medication review, mapping, and collaboration with a psychiatrist are essential for safe and effective TMS.


  • Augmentation strategies (e.g., ONE-D with D-cycloserine or a stimulant) may be used under strict psychiatric supervision and add monitoring requirements.


General principles


  1. Safety first. Screen for medications and medical conditions that increase seizure risk or interact with planned augmentation strategies. If seizure risk is elevated, weigh alternatives or modify the plan.
  2. Efficacy considerations. Some sedating medications (high-dose benzodiazepines) can blunt TMS response; consider minimizing sedative load when clinically safe.
  3. Individualize. Decisions to continue, taper, hold, or change medications should be individualized and documented in the psychiatry visit. Shared decision-making and informed consent are essential.
  4. Collaboration. The treating psychiatrist (or a TMS-trained prescriber) should make medication decisions in close communication with the TMS team; TMS clinics should require medication lists and med reconciliation at intake.



Medication Guidance


Generally continue


  • SSRIs / SNRIs (e.g., sertraline, escitalopram, venlafaxine) - usually safe to keep during TMS; no routine stop required.


  • Mood stabilizers (e.g., lithium) - generally continue; coordinate for bipolar cases.


Use with caution / consider adjustment


  • Benzodiazepines (e.g., clonazepam, lorazepam) - may dampen response; consider minimizing dose if clinically safe.


  • Antipsychotics (e.g., risperidone, olanzapine) - usually continue; clozapine needs special attention because of seizure risk.


 Review & adjust if needed (seizure-risk meds)


  • Bupropion - dose-related seizure risk; discuss taper/hold if other risk factors present.


  • Opioids, tramadol, certain stimulants at high doses - evaluate case-by-case; may increase seizure or sympathetic risk.


Action: Flag these at intake and discuss with the psychiatrist before treatment. (Clinics should screen for seizure risk and have protocols.)


Augmentation / experimental agents (ONE-D)


  • D-cycloserine, short-acting stimulants (e.g., lisdexamfetamine) - used in some ONE-D protocols as augmentation only under psychiatrist supervision, with informed consent and monitoring. Document timing and monitoring plan.


Read More - TMS Vs Medication



Medications that most commonly affect seizure risk


  • Higher seizure risk: bupropion, clozapine, tramadol, theophylline (rare).


  • Agents that lower seizure threshold modestly or via interactions: some antipsychotics, certain antibiotics (quinolones — discuss if relevant), stimulants in high doses.


  • Agents that raise seizure threshold (often protective): many anticonvulsants (valproate, carbamazepine, lamotrigine) - however, these can affect TMS response.


Action: Flag any high-risk meds during screening and consult psychiatry to mitigate risk.


ONE-D and augmentation - special considerations


  • Augmentation meds (e.g., D-cycloserine 125 mg, short-acting stimulants) have been used experimentally to enhance ONE-D effects; they require psychiatric oversight, informed consent, and monitoring for side effects and interactions. Document augmentation rationale and monitoring plan.


  • If using stimulants: evaluate cardiovascular status, anxiety history, and seizure risk. Consider holding stimulant dose or using a lower dose on treatment day, depending on risk/benefit.


  • Medication log: Track timing of augmentation relative to stimulation in the chart (useful for outcome interpretation).



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Psychiatrist-led workflow: coordinating medication and TMS


Below is a practical workflow your clinic can adopt. It assumes communication between the psychiatrist, TMS team, and patient.


1) Pre-treatment medication review (intake)


  • Obtain a full medication list (Rx, OTC, supplements) and the last 1–2 PHQ-9 scores. Request prior TMS mapping and session notes if applicable.


  • Identify high-risk meds (bupropion, clozapine, recent high-dose stimulants, opioid intoxication) and medical comorbidities (brain lesions, prior seizures).


2) Risk stratification & plan


  • For low risk: continue meds, document plan.


  • For moderate risk: discuss options (dose reduction, timing changes, monitoring).


  • For high risk: consider alternative protocols or require further medical clearance (neurology consult). Document the decision and rationale.


3) Shared decision & consent


Discuss the benefits/risks of medication adjustment vs continuing meds. Obtain informed consent that documents the plan and the clinician’s rationale.


Read more: Pros & Cons of TMS


4) Day-of procedures


  • Reconfirm med list and check for recent use of alcohol or recreational drugs.


  • Implement agreed changes (e.g., withhold morning dose of stimulant, give augmentation med at specified time).


  • Ensure resuscitation/seizure protocol is in place.


5) Monitoring & documentation


Use PHQ-9 or other PROMs for outcome tracking. Document any side effects, seizure-like events, or medication reactions. Ensure follow-up psychiatry appointments to manage tapering/resumption of meds.


6) If an adverse event occurs


Follow emergency TMS clinic protocols (stabilize the patient, call emergency services if needed). Review the med list and consult neurology/psychiatry to determine next steps.


Practical checklist for psychiatry/TMS intake


  • ☐ Full med list recorded (Rx/OTC/supplements)


  • ☐ Prior TMS records requested/uploaded (if available)


  • ☐ Seizure risk screen completed (past seizures, head trauma, medications)


  • ☐ Cardiovascular & other medical clearances as needed


  • ☐ Plan documented (continue/hold/taper/augment) + informed consent


  • ☐ Day-of medication instructions communicated to patient


  • ☐ Emergency & seizure protocol reviewed with staff


  • Should I stop SSRIs before TMS?

    No - SSRIs/SNRIs are typically continued. Stopping them is rarely necessary and may worsen mood instability. Individual exceptions are rare.


  • My patient is on bupropion - what do I do?

    Evaluate seizure risk. Where other risk factors exist, consider dose reduction or temporary hold in coordination with the prescriber; avoid abrupt discontinuation.

  • Can we do ONE-D with augmentation?

    Yes, but only with psychiatric supervision, documented consent, and a monitoring plan for side effects and interactions. Record timing relative to stimulation.


    Read More: One-D TMS

Every Question Answered

Want to know more about TMS? Check out this in-depth guide to TMS therapy with transparent and easy to understand explanations about TMS processes, protocols, and treated conditions.

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