TMS is a non-surgical depression treatment whose common effects are temporary scalp discomfort and headaches, but screening and clinician monitoring are needed to manage risks.
TMS Side Effects and Safety: An Idaho Patient Guide
Transcranial magnetic stimulation, usually called TMS, is a non-surgical treatment that uses magnetic pulses to stimulate targeted areas of the brain. It does not require anaesthetic, and patients are awake and able to return home afterwards.
In the United States, TMS was cleared by the FDA for major depressive disorder in 2008. Clearance was later expanded to include depression with comorbid anxiety in 2021. Whether TMS is suitable for an individual depends on their diagnosis, health history, medicines and the treatment protocol being considered.
For many people, side effects are mild and manageable. However, like any medical treatment, TMS has risks and requires proper screening. A clinician should review your medical history before treatment starts and should be told about any changes during the course.
What a TMS session feels like
During treatment, a clinician positions a magnetic coil against the scalp. The coil makes clicking sounds and delivers pulses that may feel like tapping, knocking or a brief tightening sensation on the scalp.
A standard course is often around 36 weekday sessions, usually delivered over six to nine weeks. The precise schedule can vary according to the treatment plan and clinic.
You do not need to be sedated for TMS. Most people can drive themselves home, work, study or continue with usual daily activities after a session, unless their clinician advises otherwise.
Clinics should provide hearing protection because the treatment coil produces repetitive clicking sounds.
Common TMS side effects
The most common side effects are temporary discomfort around the treatment area and headaches.
Scalp discomfort
Some people notice tenderness, pressure, tingling or a tapping sensation on the scalp during treatment. This is often most noticeable during the first few appointments, while the person becomes used to the sensation.
Tell the clinician if treatment feels painful or difficult to tolerate. They may be able to adjust the coil position or settings while still following the planned protocol. Do not simply try to endure severe discomfort.
Headache
A mild to moderate headache can occur after a session, particularly early in treatment. It may settle on its own or improve with rest, fluids or an over-the-counter pain medicine if that is normally safe for you.
Before taking any medicine, check with your usual clinician or pharmacist if you have health conditions, take prescription medicines or are unsure what is appropriate.
Other possible short-term effects
Some people may also experience:
- Facial muscle twitching during the pulses
- Temporary jaw discomfort
- Tiredness after an appointment
- Light-headedness or mild dizziness
- Anxiety or apprehension before early sessions, especially if the treatment is unfamiliar
These effects should be discussed with the treatment team, particularly if they are persistent, worsening or affecting daily life.
The rare risk of seizure
Seizure is the most serious recognised risk of TMS, but it is rare when treatment is appropriately screened and delivered within recommended safety procedures.
A seizure is a sudden episode of abnormal electrical activity in the brain. People with a history of seizures or epilepsy are not automatically unsuitable for TMS, but they need careful assessment. The clinician may need information from other members of your healthcare team before deciding whether treatment is appropriate.
Certain factors can affect seizure risk. These can include some medicines, major changes in medicine dose, sleep deprivation, heavy alcohol use, recreational drug use, or a medical condition that lowers the seizure threshold.
It is important to be open about these issues. The purpose is not to judge you or deny care unnecessarily; it is to help the clinician make the treatment as safe as possible.
Who may not be suitable for TMS?
TMS safety screening is particularly important for people with metal or electronic devices in or near the head.
The magnetic field can interact with some implanted devices or metal objects. Dental fillings, braces and most ordinary dental work do not usually prevent TMS, but the treating clinic must still confirm this.
You should tell the clinician if you have, or have ever had:
- A cochlear implant
- Implanted electrodes or stimulators
- A neurostimulator or implanted pump
- A metal plate, clip, bullet fragment or other metal object in the head or face
- Brain surgery, including clips used for aneurysms
- An implanted medical device whose safety with TMS is uncertain
The exact restrictions depend on the type, material and location of the device, as well as the TMS system being used. Do not assume that a device is safe or unsafe based only on an online description. Ask the clinic to review it.
A previous head injury, stroke, brain tumour, neurological illness or history of fainting should also be discussed. These do not necessarily rule out TMS, but they may change the assessment.
What to tell your TMS clinician
Your treatment team needs a full and current picture of your health. Bring a list of prescription medicines, non-prescription medicines, supplements and any recent medication changes.
Be sure to mention:
- Any personal or family history of seizures or epilepsy
- Previous head injury, concussion, stroke or brain surgery
- Implanted devices, metal fragments or other medical hardware
- Current and past mental health diagnoses
- A history of mania, hypomania, bipolar disorder or psychosis
- Alcohol use, recreational drug use or recent withdrawal from alcohol or drugs
- Major sleep disruption or prolonged lack of sleep
- Pregnancy, plans for pregnancy or breastfeeding
- New physical symptoms or changes in your health during treatment
It is especially important to report medicine changes promptly. Some medicines can affect seizure threshold, and a clinician may need to reassess safety if a dose is started, stopped or substantially changed.
If you are receiving care from a GP, psychiatrist, neurologist or another prescriber, ask how communication will be managed between them and the TMS clinic.
Monitoring during a course of treatment
Safety screening is not only something that happens at the first appointment. Your clinical team should check in regularly about side effects, changes in medicines, sleep, mood and any new health concerns.
Tell the clinic if headaches become more intense, scalp discomfort does not improve, or you develop symptoms that concern you. It is also important to report changes in mood, including agitation, unusually elevated mood, impulsive behaviour or worsening depression.
TMS is often delivered over several weeks, so practical matters can affect safety too. Try to attend sessions well rested, follow the clinic’s guidance about alcohol and medicines, and let staff know if you are unwell on the day of treatment.
If you feel at immediate risk of harming yourself or someone else, seek urgent help through emergency services or a crisis service rather than waiting for the next TMS appointment.
Finding a TMS provider in Idaho
TMS Therapy Idaho currently lists 37 published clinics across the state. Directory listings include clinics in Boise, Meridian, Pocatello, Rexburg, Idaho Falls, Twin Falls, Nampa, Chubbuck, Caldwell, Post Falls, Eagle and Jerome.
When contacting a clinic, consider asking:
- Who completes the medical and safety assessment?
- How are headaches or scalp discomfort managed?
- What happens if medicines change during treatment?
- How does the clinic assess seizure risk?
- Who should you contact outside appointment hours if you have concerns?
- Does the clinic coordinate with your existing mental health or medical provider?
Insurance arrangements vary by plan and provider. Carriers commonly seen in Idaho include Blue Cross of Idaho, Regence BlueShield of Idaho, Select Health, PacificSource, Mountain Health Co-Op, UnitedHealthcare, Idaho Medicaid and Medicare. A clinic can explain its own billing process, but it is sensible to confirm cover, authorisation requirements and out-of-pocket costs directly with your insurer.
Getting help in Idaho
Use the TMS Therapy Idaho clinic listings to find local providers, review the insurance guide for general cover information, or visit the contact page for help using the directory.
This is educational information, not medical advice.
This page is informational and is not medical advice.