TMS Side Effects and Safety: A New York Patient Guide

TMS Side Effects and Safety: A New York 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 current passing directly through the body. During treatment, a clinician places a magnetic coil against the scalp while you remain awake and seated.

For many people, side effects are mild and improve as treatment continues. However, TMS is still a medical treatment and needs a proper safety assessment. This guide explains common effects, less common risks, when TMS may not be suitable, and what to discuss with a clinician before starting.

What treatment usually feels like

During a session, the TMS coil makes a tapping or clicking sound and creates a magnetic pulse. You may feel tapping, pressure or a tightening sensation on the scalp beneath the coil. Some people notice movement in the muscles around the forehead, eyebrow or jaw during pulses.

A standard course commonly involves about 36 weekday sessions over six to nine weeks. The first appointment may take longer because the clinician needs to identify the treatment area and adjust settings for you. Later sessions are generally shorter.

You can usually return to normal daily activities after a session. TMS does not normally require sedation, so many people can travel home independently. Your own clinician can advise if there is any reason your circumstances are different.

Common side effects

The most commonly reported side effects of TMS are scalp discomfort and headache. These are generally temporary and tend to be most noticeable at the beginning of a course.

Scalp discomfort

The magnetic pulses can feel uncomfortable, particularly while you are getting used to treatment. The sensation may range from mild tapping to a sharper feeling at the treatment site. It can sometimes cause tenderness in the scalp or facial muscles.

Tell the technician or clinician if the feeling is painful or difficult to tolerate. They may be able to alter the coil position, adjust the settings gradually or discuss other practical steps to make treatment more comfortable. You should not feel that you have to simply endure severe discomfort.

Headache

A mild headache can occur during or after a session. For some people, this settles with rest, hydration or an over-the-counter pain reliever that is safe for them to use. Ask your clinician before taking any medicine if you are unsure, particularly if you have other health conditions or take regular medication.

Contact the clinic if headaches are severe, persist, change significantly, or occur with concerning symptoms such as confusion, weakness, vision changes or loss of consciousness.

Other short-term effects

Some people may experience:

• Tiredness after an appointment
• Temporary facial muscle twitching during treatment
• Light-headedness
• Discomfort from the sound of the machine
• Anxiety or worry about an unfamiliar treatment experience

Earplugs are normally provided because TMS produces repeated clicking sounds. Use them as instructed. If you have hearing difficulties, tinnitus or another ear-related condition, mention this before treatment begins.

Rare but serious risks

The most serious recognised risk of TMS is a seizure. This is rare, especially when treatment is provided using appropriate screening and established safety procedures. Nonetheless, it is important to understand that the risk is not zero.

A seizure is more likely to be a concern if a person has a history of seizures or epilepsy, a brain injury or neurological condition, significant sleep deprivation, heavy alcohol use or sudden alcohol withdrawal. Some medicines can also lower the seizure threshold. Your clinician will ask about these factors before deciding whether TMS is appropriate.

If you have a seizure during treatment, the clinical team should stop the session and provide appropriate medical care. A history of seizure does not automatically mean TMS is impossible, but it requires an individual assessment by a suitably qualified clinician.

There is also a small possibility of changes in mood or behaviour. In particular, people with bipolar disorder should be assessed carefully, as antidepressant treatments can sometimes be associated with mania or hypomania. Tell the clinician if you have ever had periods of unusually elevated mood, reduced need for sleep, racing thoughts, impulsive behaviour or increased activity.

Seek urgent medical help for symptoms such as a seizure, fainting, sudden confusion, severe new headache, chest pain, or thoughts of harming yourself or others.

Who may not be suitable for TMS

TMS is not appropriate for everyone. A key issue is the presence of metal or electronically operated devices in or close to the head. The magnetic field may affect certain implants or cause some metal objects to move or heat up.

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

• Metal fragments in the head or face, including from past injuries
• Aneurysm clips or other implanted metal devices in the head
• Cochlear implants
• Deep brain stimulators or other implanted neurostimulators
• Implanted pumps or devices with electronic or magnetic components
• A history of brain surgery
• Dental work, braces or retainers
• Permanent makeup, tattoos or cosmetic implants, particularly if you are unsure about their materials

Not all metal implants prevent TMS. Dental fillings and many forms of dental work, for example, may not be a problem. The important point is not to make assumptions. The treating team needs accurate information about the device, where it is located and, where possible, the manufacturer and model.

Pregnancy, breastfeeding, heart conditions and implanted cardiac devices should also be discussed. These circumstances do not necessarily rule out TMS, but they may affect the assessment and planning of care.

What to tell your clinician before treatment

A thorough medical history helps the clinic assess safety and tailor treatment. Bring a list of your diagnoses, medicines, supplements and any implants or previous procedures.

Be open about your mental health history, including previous treatments, hospital admissions, suicidal thoughts, psychosis, mania or hypomania, substance use, and any history of self-harm. This information is relevant to treatment planning, not a reason to judge you.

It is particularly important to mention:

• Any past seizure, epilepsy diagnosis, blackout or unexplained loss of consciousness
• Head injury, stroke, brain tumour, neurological illness or severe migraine history
• Current and recent medicines, including antidepressants, stimulants, sedatives and anti-seizure medicines
• Changes in medication during your course of TMS
• Alcohol use, recreational drug use or withdrawal from alcohol or drugs
• Poor sleep, especially if you have had very little sleep before an appointment
• Hearing problems, tinnitus or sensitivity to sound
• Any new symptoms or major life changes during treatment

Do not stop prescribed medication or change a dose solely because you are beginning TMS unless the clinician managing that medication advises you to do so. Medication changes can affect both your wellbeing and the treatment team’s safety assessment.

Safety during a course of TMS

Safety screening should not end after the first appointment. Tell the clinic if you become unwell, start a new medicine, have a change in alcohol or substance use, experience major sleep loss, or develop a new neurological symptom.

Attend appointments well rested where possible, and avoid arriving intoxicated or in withdrawal. If you are unsure whether you should attend after a difficult night, illness or medication change, call the clinic first.

You should also discuss any side effects early. A mild headache or scalp discomfort may be manageable, but the team needs to know how treatment is affecting you. Regular communication can help them decide whether adjustments are needed.

Finding TMS information in New York

TMS Therapy New York currently lists 223 published clinics across the state. Directory listings include clinics in communities such as New York, Mount Kisco, Garden City, Buffalo, Rochester, White Plains, Albany, Yonkers, Syracuse and New Rochelle, as well as Carmel Hamlet and Park Slope.

Before booking, ask a prospective clinic who will complete your medical assessment, how they handle seizures and other urgent events, and how you can contact the clinical team between sessions. It is also reasonable to ask how they review side effects and medication changes during the course.

Insurance arrangements vary by plan and provider. Carriers commonly seen in New York include Empire BlueCross BlueShield, EmblemHealth / HIP, Fidelis Care, Aetna, Cigna, UnitedHealthcare / Oxford, NY Medicaid Managed Care, and Medicare including Advantage plans. Confirm eligibility, prior authorisation requirements and out-of-pocket costs directly with both the clinic and your insurer.

Getting help in New York

Use the TMS Therapy New York clinic listings to compare published providers, review the insurance guide for cover-related questions, or visit the contact page for help using the directory.

This is educational information, not medical advice.