TMS Side Effects and Safety: A Minnesota Patient Guide

TMS Side Effects and Safety: A Minnesota Patient Guide

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate targeted areas of the brain. It is most often considered for major depressive disorder when other treatments have not provided enough benefit 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 does not involve surgery, anaesthesia or electrical currents passing through the body. During treatment, a clinician places a magnetic coil against the scalp while you remain awake and seated.

For many people, safety questions are just as important as questions about whether TMS may help. This guide explains the usual side effects, less common risks, important screening issues and what to discuss with a TMS clinician in Minnesota.

What a TMS session feels like

A TMS session usually involves repeated clicking sounds and a tapping or knocking sensation on the scalp. The magnetic pulses can cause small movements or twitching in facial muscles near the treatment area, particularly early in a course of treatment.

A standard course commonly involves around 36 weekday sessions over six to nine weeks, although the exact schedule can vary. The first appointment may take longer because the clinician needs to identify the treatment location and establish settings that are appropriate for you.

TMS does not usually require recovery time after a session. Many people return to work, study, driving or usual daily activities straight afterwards, unless their own clinician gives different advice.

Common side effects

The most common side effects of TMS are scalp discomfort and headache. These are generally mild to moderate and often improve as a person becomes accustomed to treatment.

Scalp discomfort

The coil rests against the head and delivers repeated magnetic pulses. This can feel uncomfortable, especially at the beginning of treatment. Some people describe pressure, tapping, tingling or tenderness around the treatment site.

If discomfort occurs, tell the treatment team rather than trying to tolerate it silently. The clinician may be able to adjust the coil position, check its fit or discuss whether changes to the treatment settings are suitable. They may also suggest practical measures for managing temporary soreness.

Headache

Headache can occur during or after a TMS session. For many people, it is temporary and manageable. A clinician may discuss whether your usual pain relief is appropriate, taking account of your medical history and other medicines.

Let the clinic know if headaches become severe, persistent, unusual for you or are accompanied by other symptoms. A new or worsening headache should not simply be assumed to be part of treatment.

Other temporary effects

Less commonly, people may notice:

• Fatigue or tiredness after a session
• Light-headedness
• Facial muscle twitching during treatment
• Temporary changes in hearing comfort because of the clicking sound
• Anxiety or discomfort related to the unfamiliar sensation of treatment

Clinics should provide hearing protection during sessions. If you have hearing difficulties, tinnitus or other hearing concerns, mention them during screening and again if symptoms change during treatment.

The rare risk of seizure

Seizure is the most serious recognised risk of TMS, but it is rare. A seizure is a sudden episode of abnormal electrical activity in the brain that may involve involuntary movements, altered awareness or loss of consciousness.

TMS providers use screening and established treatment procedures to reduce this risk. Your clinician will want to know about any personal history of seizures or epilepsy, as well as factors that could lower the seizure threshold. These can include certain medicines, recent changes in medication, significant sleep deprivation, heavy alcohol use, withdrawal from alcohol or some drugs, and some neurological conditions.

Having a factor that needs discussion does not necessarily mean TMS is unsuitable. It means the clinician needs a full and accurate picture before deciding whether treatment can be provided safely and how it should be planned.

If you develop symptoms that could suggest a seizure, such as unexplained loss of awareness, unusual uncontrolled movements or a collapse, seek urgent medical help. If this happens in or around a treatment session, inform the TMS clinic as soon as possible.

Who may need extra screening or may not be suitable

TMS is not appropriate for everyone. The safety assessment is particularly important if you have metal or implanted devices in or close to the head.

You should tell the clinician if you have, or may have:

• Metal fragments, shrapnel, clips, plates or other metal in the head or neck
• A cochlear implant
• A brain stimulator, implanted electrodes or another implanted neurostimulation device
• An implanted pump or other electronic medical device
• A history of brain injury, stroke, epilepsy or seizures
• A neurological condition that affects the brain
• Significant hearing problems
• Pregnancy or plans to become pregnant
• A current or past diagnosis of bipolar disorder, mania or psychosis

Not all metal implants create the same concern. Dental fillings and braces, for example, are different from implanted devices or metal close to the treatment area. Do not make assumptions based on a general list online: provide the details, including implant cards or surgical information if you have them, so the clinic can assess your individual situation.

A TMS provider may also need to consider whether your symptoms could be related to another condition requiring a different type of assessment or treatment.

What to tell your TMS clinician

A thorough consultation is part of safe TMS care. Bring an up-to-date list of your medicines, including prescribed medicines, over-the-counter products, supplements and any substances you use recreationally.

It is especially important to mention:

• Previous seizures, fainting episodes or unexplained blackouts
• Family history of epilepsy, if known
• Recent changes to antidepressants, stimulants, sedatives or other medicines
• Alcohol use and any recent reduction or withdrawal
• Sleep problems, particularly severe lack of sleep
• Past head injury or concussion
• Brain surgery or implanted medical devices
• Pregnancy, breastfeeding or pregnancy plans
• Previous TMS, electroconvulsive therapy or other psychiatric treatment
• Any history of mania, hypomania, psychosis or bipolar disorder

Keep the clinic updated during the course, not only at the initial appointment. Tell them if you begin a new medicine, stop a medicine, become unwell, sleep very poorly, drink more alcohol than usual or experience any new neurological symptoms.

It can also help to tell the clinician about practical concerns. If scalp sensitivity, headaches, anxiety about the equipment or travel fatigue makes sessions difficult, the team may be able to help you plan treatment more comfortably.

Questions to ask before starting

A Minnesota TMS clinic should be able to explain how it screens for safety, who will oversee your treatment and what happens if you experience side effects.

Useful questions include:

• What side effects should I expect, and when should I contact the clinic?
• How will you assess my seizure risk?
• Are any of my medicines or health conditions relevant to TMS safety?
• What hearing protection will be used?
• Who should I contact outside treatment hours if I have concerns?
• What would happen if I needed to pause or stop treatment?

You may also wish to ask about insurance verification and prior authorisation. Minnesota plans commonly encountered by patients include Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, UCare, Aetna, Cigna, Minnesota Medical Assistance (Medicaid), Medicare and Medicare Advantage plans. Coverage and approval requirements can differ by plan and by individual circumstances.

Finding a TMS provider in Minnesota

TMS Therapy Minnesota currently lists 136 published clinics across the state. Directory listings include clinics in communities such as Edina, Saint Paul, Maple Grove, Duluth, Mankato, Burnsville, Stillwater, Maplewood, Rochester, Minnetonka, Baxter and Woodbury.

Location can matter during a course involving regular weekday appointments. When comparing clinics, consider journey time, appointment availability, accessibility, insurance arrangements and whether the provider has experience assessing the health concerns most relevant to you.

Getting help in Minnesota

Use the TMS Therapy Minnesota clinic listings to find providers, review the insurance guide for coverage information, and visit the contact page if you need help using the directory.

This is educational information, not medical advice.