TMS for depression is a non-surgical outpatient treatment whose common temporary effects include scalp discomfort and headaches, with clinicians able to adjust settings for tolerance.
TMS Side Effects and Safety: A Missouri Patient Guide
Transcranial magnetic stimulation (TMS) is a non-surgical treatment that uses magnetic pulses to stimulate targeted areas of the brain. It is most often discussed for major depressive disorder, particularly when previous treatments have not provided enough improvement or have caused difficult side effects.
TMS was cleared by the FDA for major depressive disorder in 2008, and for depression with comorbid anxiety in 2021. It is delivered while the person is awake and seated in a treatment chair. A standard course commonly involves around 36 weekday sessions over six to nine weeks, although the exact plan can differ between patients.
Like any medical treatment, TMS has potential side effects and safety considerations. Understanding these before an assessment can help you have a clearer conversation with a clinician.
What TMS treatment feels like
During a session, a treatment coil is placed against the scalp. It produces repeated magnetic pulses, often accompanied by a tapping or clicking sound.
Some people describe a tapping sensation on the head or a pulling feeling in the scalp or face. The clinical team can adjust the position of the coil and discuss whether the intensity feels tolerable. You should tell the technician or clinician if you are uncomfortable during a session rather than trying to wait it out.
TMS does not involve surgery, anaesthesia or electrical current passing through the body. People are generally able to return to their usual activities after a session, unless their own clinician advises otherwise.
Common TMS side effects
The most common side effects are temporary and tend to occur during treatment or shortly afterwards. They can include:
- Scalp discomfort at the treatment site
- Headache
- A sensation of tapping, pressure or twitching in the facial muscles during pulses
- Mild discomfort around the jaw or forehead
- Tiredness, particularly if frequent appointments are difficult to fit around daily life
Headache and scalp discomfort are the side effects most often raised by patients. For some people, these symptoms are more noticeable at the beginning of a course and become easier to manage as treatment continues. Others may find that the sensations remain uncomfortable and need adjustments.
It is important not to assume discomfort is something you must simply accept. The treatment team may be able to alter coil placement, review the stimulation settings or discuss suitable ways of managing headache. Do not start or change medication for TMS-related symptoms without checking with the clinician responsible for your care.
Rare but important risks
The most serious recognised risk of TMS is seizure. This is rare, but it is an important part of the safety discussion before treatment begins.
Clinicians assess seizure risk carefully before starting TMS. They may ask about previous seizures, epilepsy, significant head injury, neurological conditions, alcohol or substance use, sleep patterns, and medicines that could affect seizure risk. You may also be asked about major changes in medication or health during the treatment course.
Let the clinic know promptly if you have had very little sleep, have been unwell, have changed medication, or have made significant changes to alcohol or substance use. These details can matter to safe treatment planning.
Other uncommon concerns may include hearing discomfort from the repeated clicking noise. Clinics normally provide ear protection during sessions. Use it as directed, and say if you are worried about your hearing or find the noise distressing.
TMS is not known for causing the widespread memory difficulties sometimes associated with electroconvulsive therapy (ECT). However, every treatment has individual considerations, and it is reasonable to ask how the clinician will monitor your wellbeing and progress throughout the course.
Who may not be suitable for TMS
TMS is not suitable for everyone. The main safety concern is certain metal or electronic devices in or close to the head, because of the magnetic field produced by the treatment coil.
A clinician will need to know if you have any implanted device or metal fragment, especially in the head or neck area. Examples may include:
- Cochlear implants
- Some implanted neurostimulators
- Metal clips, plates or fragments near the head
- Certain aneurysm clips
- Other implanted electronic devices
Having metal elsewhere in the body does not automatically mean TMS is unsuitable. The location, type and purpose of the device all matter. Do not make assumptions based on general information online. Bring any implant card, device details or relevant surgical information to your assessment if possible.
A history of seizures does not always automatically rule out treatment, but it requires careful clinical review. The same is true of neurological illness, previous brain surgery or serious head injury. The clinician may decide TMS is not appropriate, recommend further information from another medical professional, or discuss a modified plan where appropriate.
If you are pregnant, trying to conceive or breastfeeding, tell the clinician. They can discuss the available evidence, your mental health needs and whether TMS is appropriate in your circumstances.
What to tell your TMS clinician
A thorough assessment is central to TMS safety. Be open about your medical history, even if you are unsure whether something is relevant. Information that may be useful includes:
- Previous seizures, fainting episodes or epilepsy
- Head injury, concussion, stroke, brain surgery or neurological conditions
- Any metal, implant or electronic medical device in your body
- Current medicines, including antidepressants, sleeping tablets, stimulants, pain medicines and over-the-counter products
- Recent medication changes or plans to stop medicines
- Alcohol, recreational drug or substance use
- Sleep problems, including severe sleep deprivation
- Pregnancy, breastfeeding or plans for pregnancy
- Hearing concerns or use of hearing devices
- Past treatment for depression, anxiety or other mental health conditions
It is also worth telling the clinician about practical concerns. For example, regular weekday appointments may affect work, study, transport, childcare or caring responsibilities. A standard course is usually delivered over several weeks, so it helps to discuss how attendance will work before treatment starts.
Questions to ask before starting
You do not need to have all the answers at your first appointment. A good assessment should give you time to ask questions and consider the information.
Useful questions may include:
- Why do you think TMS is appropriate for me?
- What side effects are most likely in my situation?
- Do any of my medicines or health conditions affect safety?
- What should I do if I get a headache or scalp discomfort?
- Who should I contact if I feel unwell between sessions?
- What happens if I miss an appointment?
- How will you review whether treatment is helping?
- Are earplugs provided during treatment?
- What costs may be covered by my insurance plan?
Insurance arrangements vary by plan, clinic and clinical circumstances. In Missouri, people may see plans from Anthem Blue Cross and Blue Shield (Missouri), Blue Cross and Blue Shield of Kansas City, UnitedHealthcare, Cigna, Aetna, Humana and MO HealthNet (Missouri Medicaid). A clinic can explain its own billing process, but you may still need to confirm eligibility, referral requirements, prior authorisation and out-of-pocket costs directly with your insurer.
Safety during a course of treatment
Safety checks do not end after the first assessment. Keep the clinic informed throughout the course if anything changes.
Contact the treatment team before a session if you develop a new medical problem, begin a new medicine, stop a medicine, have a seizure, experience a significant head injury, or have major changes in sleep or substance use. It is also sensible to mention severe or persistent headaches, new neurological symptoms, or any reaction that worries you.
Do not drive yourself through serious symptoms or wait until the next routine appointment if you need urgent help. For an emergency or immediate safety concern, use local emergency services.
Missouri patients may have different travel and scheduling needs depending on where they live. TMS Therapy Missouri currently lists 71 published clinics, including listings in Joplin, St. Louis, St. Peters, Jefferson City, Rolla, Columbia, Lee’s Summit, Festus, Neosho, Sedalia, Arnold and Springfield. Availability, assessment procedures and insurance participation can differ between providers, so confirm details directly with the clinic.
Getting help in Missouri
Use the TMS Therapy Missouri clinic listings to find published local options, the insurance guide to understand coverage questions, and the contact page for help using the directory.
This article is educational information, not medical advice.
This page is informational and is not medical advice.