What is a TMS “dip”? Is it real?

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FLORIDA TMS CLINIC
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At Florida TMS Clinic we treat depression differently. We use TMS or Transcranial Magnetic Stimulation. TMS is an effective, proven treatment for depression that is FDA approved and covered by insurance. TMS is safe and has no systemic side effects. While antidepressant medications and psychotherapy can be helpful for some, many others don't respond to medications and therapy. Some others may not be able to tolerate the side effects of medications. TMS therapy is a drug-free alternative treatment for depression. We love what we do! We enjoy seeing our patients blossom throughout their treatment course with TMS therapy.
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Disclaimer: Although I am a psychiatrist, this is not professional advice as I am not familiar with the specifics of your unique situation; please contact a psychiatrist in your area with more questions. This disclaimer is added to my answers on social media after consulting with the American Psychiatric Association.
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[@kimconley1767]

I had tms treatment 5 days a week for 6 weeks. The dips are a beast. Its awful. But I don’t cry everyday anymore. So I guess its helping slowly. But the dips continue the past 3 weeks, and its awful.

[@MrDayinthepark]

This report makes intuitive sense, if the placebo effect can make you think you're getting better, it could just as easily make you feel you're worsening.

[@realitymodifyyarnrealitymo9003]

You mentioned “the book on TMS therapy” - can you share what the title is? Thanks for your videos.

[@floridatmsclinic1239]

3000 Pulses Later by Martha Rhodes. We give a copy of it to every patient during their first visit. Martha is amazing and helped many. 3000pulseslater.com/

[@taylorh520]

Hi Dr. Khaled Bowarshi,
I understand that SAINT total 90,000 iTBS 50Hz pulses, that is 5 times of the 90, 000 rTMS 10Hz pulses of conventional TMS (30 sessions x 3000) treatment course. SAINT has far more pulses, 5 times as much, far more dosages than the conventional TMS. That is not fair comparison. fMRI is not that important, isn't it? the current FDA approved iTBS protocol is 600 iTBS pulses per session. That means that whole course of 30 sessions of iTBS protocol is only 18,000 iTBS, i.e. again only 1/5 of SAINT dosage.
Most FDA approved TMS is about 50% response rate, (50% improvement of depression score). SAINT claims 70-80%. We must understand they are hugely different in dosage in terms of number of pulses. This is not a fair comparison.
I wonder if FDA also could approve total 90,000 iTBS TMS treatment course, will that be a lot higher efficacy. Do you strongly recommend that to FDA or TMS manufacturerers?
SAINT appeared back in April 2020. Already over 3 years, why isn't there any industry wide increasing to 90,000 iTBS pulses? and why isn't there accelerated TMS highly recommended by your TMS physicians?