In 2024, seeking treatment for a mental health disorder is far different than twenty years ago, and for men, one reason a new treatment called transcranial magnetic stimulation (TMS) is growing in popularity is the absence of sexual side effects.
One difference between finding treatment twenty years ago, compared to now, is related to stigma. Or, rather, the reduction of stigma around treatment for mental health diagnoses. The components that contributed to the decades-long stigma around mental health treatment included:
- Lack of education
- Lack of awareness
- Fear
- Judgment
To put those all together to understand stigma, we’ll say it like this: a lack of education about the basics of mental health led to a lack of awareness about the important fact that mental health disorders are treatable medical conditions, which led to fear of seeking treatment because of the judgment based on a lack of education and awareness about mental health, mental health diagnoses, and the evidence-based treatment of mental health diagnoses.
Thankfully, those days are almost gone, and the amount of real education and awareness about mental health and mental health disorders is gradually becoming more prevalent than the amount of poor information and misunderstanding.
There are two things, however, that the 280 million people (World Health Organization, WHO) around the world who experience clinical depression:
- Standard, traditional treatment is not always effective.
- For many patients with depression, standard antidepressants have significant side effects, including sexual dysfunction.
That’s why many people with depression now seek an innovative new treatment called transcranial magnetic stimulation (TMS).
What is Transcranial Magnetic Stimulation (TMS)?
After a thorough analysis of peer-reviewed research to determine the safety and efficacy of TMS, the Food and Drug Administration (FDA) approved TMS for the treatment of three mental health disorders and two additional medical issues in 2008. Approval included treatment for:
- Major depressive disorder (MDD)
- Treatment-resistant depression (TRD)
- Obsessive-compulsive disorder (OCD)
- Migraines
- Smoking cessation
The following statistics from the National Institute on Mental Health (NIMH), the National Survey on Drug Use and Health (2022 NSDUH), the Centers for Disease Control (CDC) show the current prevalence of diagnoses and/or conditions that respond positively to treatment with TMS, for which TMS is FDA-approved.
Prevalence: Conditions TMS Can Help
Major depressive episode (MDE):
- Among adults (18+): 6.2% (15.8 million) total
- MDE with severe impairment: 8% (5.0 million) total
Treatment resistant depression (TRD):
- 31% of people with major depressive disorder (MDD)
- 9 million people
Obsessive-compulsive disorder:
- Lifetime diagnosis: 2.3% (5.9 million)
- Past-year diagnosis: 1.2% (3.1 million)
Migraine headaches:
- Lifetime presence: 13.5% (35 million)
- Daily migraines: 1.5% (3.8 million)
Cigarette smoking:
- Daily smoker: 11.5% (28.3 million)
- With smoking-related disease: 6.2% (16 million)
Evidence and information from a wide range of sources – including this article from Harvard Medical School – show that TMS can create positive change for people with these diagnoses in ways that no other treatments can.
In this article, we’ll focus on the impact of TMS on depression.
For depression – and all the issues we list above – TMS works by sending pulses of electromagnetic energy to brain areas that regulate mood and emotion, which decreases symptoms of depression. People with depression who seek treatment with TMS must have tried treatment at least two different courses of antidepressant medication of appropriate/medically recommended dosage and duration. Treatment with TMS does not require anesthesia or hospitalization, and there are no systemic side effects.
That brings us to an important – and crucial – differentiator between TMS and depression treatment with antidepressants: the side effects. We’ll focus on one side effect of antidepressants that keep many people from seeking treatment with antidepressants: sexual dysfunction.
Antidepressants and Sexual Side Effects
Please don’t misunderstand us: we’re not anti anti-depressant. However, we do understand that for some people with depression, the complications presented by the side effects are less tolerable than the symptoms of depression itself. This is particularly true for sexual side effects. In fact, five of the most common antidepressants include sexual side effects that impact a significant number of people who use them for depression treatment. The paper “Management Strategies for Antidepressant-Related Sexual Dysfunction: A Clinical Approach” reports the following data on common antidepressants and sexual dysfunction.
Sexual Dysfunction: Impact of Antidepressants
Fluoxetine (Prozac):
- Overall dysfunction: 15.59%
- Reduced desire: 45.59%
- Difficulty with orgasm: 11.91%
- Problems with arousal: 31.42%
Paroxetine (Paxil):
- Overall dysfunction: 16.68%
- Reduced desire: 46.99%
- Difficulty with orgasm: 18.45%
- Problems with arousal: 44.44%
Citalopram (Celexa):
- Overall dysfunction: 20.27%
- Reduced desire: 55.30%
- Difficulty with orgasm: 14.39%
- Problems with arousal: 82.48%
Venlafaxine (Effexor):
- Overall dysfunction: 24.82%
- Reduced desire: 23%
- Difficulty with orgasm: 15.94%
- Problems with arousal: 54.04%
Sertraline (Zoloft):
- Overall dysfunction: 27.43%
- Reduced desire: 42.95%
- Difficulty with orgasm: 15.03%
- Problems with arousal: 38.58%
Those statistics may shock some people: a significant percentage of patients using antidepressants for depression report reduced desire, difficulty with orgasm, and problems with arousal. Anecdotally, we hear from our patients that men with depression may avoid treatment with antidepressants for this very reason. The negative impact on sexuality, for them, far outweighs the antidepressant benefit. However, that’s anecdotal, and not verified by available data we can find in the scientific literature on depression treatment.
With that said, anyone reading this who avoids depression treatment because of the sexual side effects – male or female – should understand that TMS does not have any systemic side effects, sexual or otherwise.
TMS, Men, and Sexual Side Effects: More About How It Works
Evidence shows TMS is an effective treatment for both depression and treatment-resistant depression – as well as obsessive-compulsive disorder (OCD), migraine headaches, and smoking cessation – but what makes TMS a realistic option for many people is a combination of the process and the absence of sexual side effects. We describe the side effects above: avoiding antidepressant to avoid the sexual side effects make sense.
But with TMS, patients don’t have to choose between experiencing their typical sexuality and experiencing relief from the symptoms of depression: they can have both. In addition, the treatment process is easy and non-invasive. Most patients receive TMS in an outpatient setting. They sit in a comfortable chair while a clinician prepares the TMS device. Sessions last about 20 minutes each, and since there are no side effects like drowsiness or sedation, patients can drive themselves to and from treatment.
Although treatment response varies by the individual patient – treatment history, medical history, symptom severity, and other factors – patients typically experience positive treatment results within four to six weeks of initiating treatment.
To learn more, please read our TMS Treatment Page.
Gianna Melendez
Jodie Dahl, CpHT