TMS Side Effects and Safety: A Colorado Patient Guide

TMS Side Effects and Safety: A Colorado Patient Guide

Transcranial magnetic stimulation, usually called TMS, is a non-invasive treatment that uses magnetic pulses to stimulate specific areas of the brain. It is most commonly used for major depressive disorder. In the United States, TMS was cleared by the FDA for major depressive disorder in 2008, and for depression with comorbid anxiety in 2021.

For many people, a course of TMS involves weekday appointments over several weeks. A standard course is often around 36 sessions over six to nine weeks, although an individual plan may differ. Sessions are usually carried out while you are awake and seated in a treatment chair.

As with any medical treatment, it is sensible to understand the possible side effects, rare risks and safety checks before deciding whether TMS is right for you. A clinic should discuss these matters with you in detail and give you an opportunity to ask questions.

What TMS treatment feels like

During treatment, the TMS coil is placed against the scalp. It makes a tapping or clicking sound as it delivers magnetic pulses. You may feel tapping, pressure or a twitching sensation in the muscles of the face or scalp near the treatment area.

The intensity is adjusted to your treatment plan and tolerance. The clinician will usually carry out an initial assessment to establish settings for treatment, and may make adjustments if you are finding sessions uncomfortable.

TMS does not involve surgery or implanted equipment. It does not require a general anaesthetic, and people generally remain awake throughout the appointment.

Common side effects

The most common TMS side effects are temporary and tend to be mild to moderate. They are often more noticeable at the beginning of a course, or after a change in treatment settings.

Common effects include:

• Scalp discomfort, tenderness or pressure where the coil rests
• Headache during or after treatment
• Tingling or twitching in the face or scalp during pulses
• Temporary jaw discomfort from facial muscle movement
• Tiredness or feeling slightly light-headed after a session

Headache and scalp discomfort are the effects most often discussed with people considering TMS. For some, the tapping sensation becomes easier to tolerate as treatment continues. Others may need adjustments to the position of the coil, the stimulation settings or the pace at which settings are increased.

Tell the clinician if you are experiencing pain rather than manageable discomfort. You should not feel that you have to simply put up with an unpleasant session. Your treatment team can assess whether changes can be made safely.

If you get headaches, ask your clinician what they recommend. They may discuss practical measures such as hydration, rest, or whether an appropriate over-the-counter pain reliever is suitable for you. Do not start or change medicines without checking with a qualified healthcare professional, particularly if you take prescription medication or have other health conditions.

Less common effects and changes in mood

Some people notice temporary changes in sleep, energy, concentration or mood during a course of treatment. Depression itself can affect all of these areas, so it may not always be clear whether a change is related to TMS, medication, life circumstances or the underlying condition.

It is important to report changes promptly, especially if you develop:

• Markedly reduced need for sleep or unusually high energy
• Racing thoughts, impulsive behaviour or a significantly elevated mood
• New or worsening agitation, anxiety or irritability
• Suicidal thoughts, thoughts of self-harm, or feeling unable to keep yourself safe

A clinician can review what is happening and decide what support is needed. If you are in immediate danger or think you may act on thoughts of harming yourself, seek urgent help through emergency services or a local crisis service.

The rare risk of seizure

Seizure is a recognised but rare risk of TMS. TMS clinics use screening procedures and carefully selected treatment settings to reduce this risk.

Your clinician will ask about factors that may affect seizure risk. These can include a personal history of seizures or epilepsy, a serious head injury, certain neurological conditions, lack of sleep, heavy alcohol use or alcohol withdrawal, and some medicines or substance use.

A previous seizure does not necessarily mean that TMS is impossible, but it does mean the treating clinician needs to consider the situation carefully. Depending on your history, they may recommend a different approach, ask for input from another clinician, or decide that TMS is not suitable.

Be open about anything that could affect safety, including sleep deprivation, recent illness, changes in medication, recreational drug use, or significant changes in alcohol consumption. This information is not there to judge you; it helps the clinic make safer decisions.

Metal, implants and other contraindications

TMS uses a strong magnetic field close to the head. For that reason, certain implanted or metal devices may make TMS unsuitable or require specialist review.

It is particularly important to tell the clinic if you have metal or electronic devices in or near your head. Examples may include:

• Cochlear implants
• Implanted brain stimulators or electrodes
• Some aneurysm clips
• Certain implanted pumps or stimulators
• Metal fragments from an injury, particularly around the head or eyes
• Previous brain or facial surgery involving implanted material

The exact type, location and manufacturer of an implant matters. Not all metal in the body creates the same issue. For example, dental work is common and should still be mentioned, but it may not prevent treatment. The clinic may ask for records, device information or imaging before making a decision.

Do not assume an implant is safe or unsafe based on information found online. The treating service should complete an individual safety screen before treatment begins.

What to tell your TMS clinician

A thorough assessment is one of the most important parts of safe TMS care. Bring a current list of medicines, including prescribed medication, pharmacy medicines, vitamins and supplements. Let the clinic know about any changes during your treatment course.

You should also discuss:

• Any history of seizures, epilepsy, fainting or serious head injury
• Migraine or other recurring headache conditions
• Bipolar disorder, mania or hypomania
• Neurological conditions or previous brain surgery
• Metal fragments, implants, hearing devices or dental work
• Pregnancy, plans for pregnancy or breastfeeding
• Alcohol use, recreational drug use or recent withdrawal
• Sleep problems, particularly severe insomnia or recent lack of sleep
• Any new diagnosis, illness or medication change since your assessment

It can help to ask the clinic what to do if you miss a session, develop a fever, have a medication adjustment or feel unusually unwell. Clear communication between appointments is part of good safety practice.

Questions to ask before starting TMS

Before choosing a provider, consider asking:

• What safety screening will you carry out before treatment?
• Who will be available if I have side effects or concerns?
• How will you monitor my progress and changes in mood?
• What happens if scalp discomfort or headaches become difficult?
• What should I tell you about medicines, alcohol, sleep or illness?
• How will you coordinate with my GP, psychiatrist or other mental health clinician, if appropriate?

Colorado has a wide range of listed options, with 114 clinics published in the TMS Therapy Colorado directory. Listings include clinics in Colorado Springs, Denver, Lakewood, Fort Collins, Boulder, Grand Junction and other Colorado communities. Availability, clinical approach and referral requirements can vary, so contact a clinic directly to ask about its assessment and safety procedures.

Getting help in Colorado

Use the TMS Therapy Colorado clinic listings to explore providers across Colorado, including the 19 published listings in Colorado Springs and 14 in Denver. The directory’s insurance guide can help you prepare questions about cover, and the contact page is available if you need help using the directory.

This is educational information, not medical advice.