TMS Side Effects and Safety: A Delaware Patient Guide

TMS Side Effects and Safety: A Delaware Patient Guide

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate targeted areas of the brain. It is commonly considered for people with major depressive disorder when other treatments have not provided enough benefit or have caused difficult side effects.

TMS was cleared by the US Food and Drug Administration (FDA) for major depressive disorder in 2008, and for depression with comorbid anxiety in 2021. A typical course involves weekday appointments over roughly six to nine weeks, often totalling around 36 sessions.

For many people, TMS is well tolerated. However, like any medical treatment, it can cause side effects and is not suitable for everyone. A proper assessment with a qualified clinician is important before treatment begins.

The most common TMS side effects

The most commonly reported side effects are scalp discomfort and headache.

During treatment, the coil rests against the head and produces repeated magnetic pulses. Some people describe a tapping, knocking, tingling or tightening sensation on the scalp. This is usually most noticeable during the first sessions, while you are becoming used to the feeling.

Scalp discomfort may occur:

• During the pulses themselves
• Around the site where the coil is placed
• In the forehead, temple or jaw area, depending on the treatment location
• Shortly after a session

A mild headache can also occur after treatment. For many patients, headaches are temporary and become less frequent as the course continues. Your clinician may be able to adjust the coil position or treatment settings if discomfort is difficult to manage. They can also advise whether your usual headache relief is appropriate for you.

It is helpful to tell the treatment team if a session feels painful rather than merely uncomfortable. You do not need to simply endure a level of discomfort that feels unmanageable.

Other possible short-term effects

Some people may experience tiredness, light-headedness, facial muscle twitching during pulses, or brief changes in concentration after an appointment. These effects are generally short-lived, but should still be mentioned to the clinician.

TMS sessions can be noisy because the machine makes a clicking sound with each pulse. Hearing protection is normally provided and should be worn throughout treatment.

You may be able to return to usual daily activities after a session, including work or travel, unless your clinician advises otherwise. If you feel dizzy, unusually tired or unwell after an appointment, it is sensible to take time before driving or carrying out tasks that require close attention.

The rare risk of seizure

Seizure is a rare but important potential risk of TMS. A seizure is a sudden episode of abnormal electrical activity in the brain. TMS providers screen carefully for factors that may increase this risk before recommending treatment.

The risk may be affected by a person’s medical history, sleep pattern, medicines, alcohol or drug use, and certain neurological conditions. This is one reason why it is important to give a full and accurate health history, even if you are unsure whether a detail is relevant.

Tell the clinician promptly if, during a course of treatment, you have:

• Had very little sleep
• Started, stopped or changed a medicine
• Used alcohol more heavily than usual
• Used recreational drugs or non-prescribed substances
• Experienced a seizure, fainting episode or unexplained loss of consciousness
• Developed a new neurological symptom

Do not make medication changes solely because you are having TMS. Instead, discuss any changes with the clinician prescribing your medicines and with your TMS treatment team.

Who may not be suitable for TMS?

TMS is not appropriate for every patient. The main concern is usually the presence of certain implanted metal or electronic devices in, or close to, the head.

A clinician will ask about implants, previous surgery and injuries. In particular, mention any history of:

• Metal fragments or shrapnel in the head or face
• Aneurysm clips
• Cochlear implants
• Implanted brain stimulators
• Electrodes, pumps or other medical devices
• Surgery involving the head, brain, ears or eyes
• Serious head injury

Some metal items are not necessarily a barrier to treatment. For example, dental fillings, crowns and braces may not prevent TMS, but the treatment team still needs to know about them. Never assume that an implant is safe or unsafe without checking with a clinician familiar with TMS safety screening.

People with a history of epilepsy or seizures may need particularly careful assessment. This does not automatically mean that TMS is impossible, but it may affect whether treatment is recommended and how it is delivered.

A clinician may also ask about bipolar disorder, psychosis, substance use, pregnancy, heart conditions and other health concerns. These questions are part of a broader safety and suitability assessment. TMS is a treatment for depression in appropriate circumstances, not a replacement for urgent psychiatric or medical care.

What to tell your TMS clinician

The safest approach is to share complete information at the first consultation and keep the team updated throughout treatment. Bring a list of all prescription medicines, over-the-counter products, supplements and vitamins you take.

It is especially important to mention medicines that affect the nervous system, including antidepressants, stimulants, sedatives, sleep medicines, anticonvulsants and medicines prescribed for pain. Your clinician will consider your individual situation; do not stop a medicine without medical advice.

You should also tell the clinician about:

• Any previous seizure or family history of seizures
• Epilepsy, stroke, brain injury or other neurological conditions
• Past or current alcohol, cannabis or other substance use
• Major changes in sleep, including severe insomnia
• Pregnancy or plans to become pregnant
• Hearing difficulties or the use of hearing devices
• New symptoms since your assessment
• Any previous experience with TMS or electroconvulsive therapy

Honesty helps the team make treatment safer. These questions are not intended to judge you; they are there to identify risks and plan care appropriately.

Safety during a course of treatment

TMS is usually delivered in a clinic setting by trained staff, with a prescribing clinician overseeing the treatment plan. Before the first session, the team will identify the treatment area and determine settings appropriate for you. The treatment plan may be reviewed if you have significant side effects, changes in health or medication changes.

Attend appointments having eaten and hydrated as you normally would, unless you have been given different instructions. Try to maintain regular sleep where possible. If you arrive after a sleepless night or feel unwell, tell the staff before treatment begins.

Ask the clinic what to do if you need to miss a session, develop a new condition or are prescribed a new medicine by another healthcare professional. A course can sometimes need adjustment, but this should be decided with the treatment team rather than by stopping without contact.

Insurance and practical questions in Delaware

Coverage for TMS can depend on your diagnosis, treatment history, clinician documentation, plan rules and whether the provider is in-network. Delaware patients may encounter plans associated with Highmark Blue Cross Blue Shield Delaware, Aetna, Cigna, UnitedHealthcare, AmeriHealth Caritas Delaware, Delaware Physicians Care, Humana or Medicare.

Before starting treatment, ask both the clinic and your insurer about prior authorisation, referral requirements, network status, expected out-of-pocket costs and what happens if the number of approved sessions changes. Insurance decisions are separate from clinical suitability, so it is worth discussing both early.

Getting help in Delaware

TMS Therapy Delaware lists 22 published clinics across the state, including listings in Wilmington, Newark, Dover, Lewes, Rehoboth Beach and other Delaware communities. Use the directory’s clinic listings, insurance guide and contact page to help compare options and prepare questions for a provider.

This article is educational information, not medical advice.