TMS Side Effects and Safety: A Maryland Patient Guide

TMS Side Effects and Safety: A Maryland Patient Guide

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate areas of the brain involved in mood regulation. It is most commonly considered for major depressive disorder, particularly when medicines or talking therapies 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. It does not involve surgery, anaesthesia or electrical current being sent directly through the skull. During treatment, a clinician places a magnetic coil against the scalp while you remain awake and seated.

For most people, TMS is well tolerated. However, it is still a medical treatment and it is important to understand possible side effects, rare risks and the information your clinician needs before treatment begins.

What treatment usually feels like

A standard course of TMS commonly involves around 36 weekday appointments, often spread across six to nine weeks. The first appointment may be longer because the clinician needs to identify the most appropriate treatment position and establish your individual motor threshold. This helps them set the treatment intensity safely.

During a session, you may hear clicking sounds from the machine and feel tapping, knocking or tingling sensations on the scalp. Clinics provide hearing protection because the pulses create repeated noise.

The sensation can feel unusual at first. Some people adapt after several sessions, while others need small adjustments to coil position or treatment settings to improve comfort. Tell the treatment team if the tapping feels painful rather than merely uncomfortable.

Common TMS side effects

The most common side effects of TMS are local and temporary. They usually occur during treatment or shortly afterwards, and often become easier to manage as treatment continues.

Scalp discomfort

Scalp discomfort is one of the most frequently reported effects. The area beneath the coil may feel tender, sensitive, tight or mildly sore during a session. Some people notice twitching in the forehead, jaw or facial muscles because the magnetic pulses can stimulate nearby nerves and muscles.

Discomfort does not necessarily mean that anything is wrong, but you should not feel that you need to endure severe pain. The clinician may be able to alter the coil position, support your head differently, adjust the treatment intensity where clinically appropriate, or pause briefly during a session.

Headache

Headache is another common side effect. It is often mild to moderate and tends to settle after treatment. Some people find that rest, hydration or their usual clinician-approved pain relief is enough. Ask your TMS clinician before taking any medicine specifically for treatment-related headaches, especially if you take other prescribed medicines or have health conditions that affect which pain relief is suitable.

Contact the clinic if headaches are severe, persist beyond the expected period, become progressively worse or are accompanied by other concerning symptoms.

Tiredness and temporary light-headedness

Some people feel tired after an appointment, particularly in the early stages of treatment. A small number may feel briefly light-headed. It can be sensible to allow a little time after early sessions before driving or returning to a demanding activity, until you know how you respond.

TMS does not usually require recovery time in the way that sedation-based procedures do. Many people continue with work, study, family responsibilities and ordinary activities during a treatment course.

Rare but important risks

The most serious recognised risk associated with TMS is seizure. This is rare, but it is why screening, treatment settings and ongoing communication with the clinical team matter.

A seizure is a sudden episode of abnormal electrical activity in the brain. The treatment team should have safety procedures in place and will assess factors that could increase seizure risk before starting TMS. If you have a seizure history, it does not automatically mean TMS is impossible, but it does mean the clinician needs to assess your individual circumstances carefully.

Tell the team promptly about any new medical issue, major sleep loss, changes in alcohol or recreational drug use, or medication changes during the course. These factors may affect seizure risk or the safety of proceeding with a session.

There is also a possibility of hearing discomfort or hearing injury if suitable hearing protection is not used. Wear the earplugs or other protection provided by the clinic for every treatment session.

People with bipolar disorder should discuss any previous mania or hypomania with their clinician. Treatments for depression can sometimes be associated with mood elevation in people who are vulnerable to bipolar mood episodes. Report symptoms such as unusually high energy, markedly reduced need for sleep, racing thoughts, impulsive decisions or feeling unusually euphoric or irritable.

Who may need extra screening

TMS is not suitable for everyone. A full assessment should cover your mental health, medical history, medicines and any implanted devices or metal near the head.

In particular, tell the clinician if you have:

• Any metal, electronic device or implanted medical device in or near the head, other than standard dental work
• A cochlear implant, implanted brain stimulator, aneurysm clip or other device that may be affected by magnetic fields
• A history of seizures, epilepsy, significant head injury, stroke or another neurological condition
• Fainting episodes or unexplained blackouts
• Bipolar disorder, psychosis or a history of mania or hypomania
• Current alcohol or drug use, or recent withdrawal from alcohol, sedatives or other substances
• Pregnancy, are trying to conceive, or are breastfeeding
• Hearing problems or a history of sensitivity to loud sounds

This is not a complete list. The key point is to give a full and accurate history, even if something seems unrelated to depression. Your clinician can then decide whether TMS is appropriate, whether additional specialist input is needed, or whether another treatment would be safer.

Medicines and changes during treatment

Bring an up-to-date list of all medicines and supplements to your assessment. Include prescription medicines, pharmacy medicines, herbal products, recreational substances and anything taken only occasionally.

Some medicines may affect seizure threshold or interact with other aspects of your health. This does not mean you should stop them independently. Do not discontinue antidepressants, sleeping tablets, anti-anxiety medicines, pain medicines or any other prescribed treatment without speaking to the clinician who manages your care.

It is especially important to tell the TMS team if a prescriber starts, stops or changes the dose of a medicine while you are having treatment. The team may need to review whether your TMS plan should be adjusted.

What to tell your clinician before each session

Safety screening is not only for the first appointment. Your circumstances can change during a course of treatment, so tell the clinic about anything relevant before a session.

Useful information to share includes:

• New headaches, illness, fever or neurological symptoms
• Significant sleep deprivation
• Any alcohol or substance use that differs from usual
• A medication or supplement change
• A new diagnosis, injury or hospital visit
• Pregnancy or a change in pregnancy plans
• Worsening depression, new agitation or suicidal thoughts
• Symptoms of mania or hypomania
• Any side effect that is becoming difficult to tolerate

If you are experiencing thoughts of harming yourself or feel unable to keep yourself safe, seek urgent help through local emergency services or a crisis service rather than waiting for a routine TMS appointment.

Questions to ask a Maryland TMS clinic

Maryland patients may find it helpful to ask practical safety questions before choosing a provider. TMS Therapy Maryland currently lists 100 published clinics, including listings in Bethesda, Columbia, Towson, Annapolis, Rockville, Baltimore, Easton, Crofton, Arnold, Frederick, California and Bowie.

Questions worth asking include:

• Who will carry out the assessment and oversee treatment?
• How are seizure risk and implanted-device risks screened?
• What happens if I develop pain, headaches or another side effect?
• How can I contact the clinical team between sessions?
• What should I do if my medicines change?
• Does the clinic coordinate with my psychiatrist, GP or other prescriber?
• What hearing protection is used during sessions?
• What are the clinic’s arrangements for urgent medical concerns?

You may also wish to ask about insurance verification. Carriers commonly seen in Maryland include CareFirst BlueCross BlueShield, UnitedHealthcare, Aetna, Cigna, Kaiser Permanente Mid-Atlantic, Maryland Medicaid HealthChoice MCOs, Medicare through Novitas Jurisdiction L and TRICARE East. Coverage and prior-authorisation requirements can vary by plan and by provider, so confirmation from both the clinic and insurer is important.

Getting help in Maryland

Use the TMS Therapy Maryland clinic listings to compare published providers, the insurance guide to understand possible coverage questions, and the contact page if you need help using the directory.

This is educational information, not medical advice.