TMS Side Effects and Safety: A Connecticut Patient Guide

TMS Side Effects and Safety: A Connecticut 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 discussed for major depressive disorder, particularly when symptoms have not improved sufficiently with medication, talking therapy, or both.

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 being passed through the body. During treatment, a clinician positions a magnetic coil against the scalp while you remain awake and seated.

As with any medical treatment, TMS has possible side effects and safety considerations. A proper assessment should take place before treatment starts, including discussion of your medical history, medication and any implanted devices.

The most common side effects

The most commonly reported TMS side effects are scalp discomfort and headache. These are generally temporary and often become easier to tolerate as treatment continues.

During a session, the magnetic pulses can feel like tapping, knocking or a brief pulling sensation on the scalp. Some people find this uncomfortable at first, especially around the treatment area. The clinician can often make practical adjustments, such as checking coil positioning or changing the treatment intensity gradually within the prescribed plan.

Headaches may occur during or after a session. They are usually mild to moderate and may settle with time, rest, hydration or an appropriate painkiller, if this is safe for you. It is important to ask your clinician or usual prescriber before taking medication for a new or persistent headache.

Other possible short-term effects can include:

• Facial muscle twitching during the pulses
• Tingling or discomfort around the scalp, forehead or jaw
• Tiredness after an appointment
• Temporary light-headedness
• Mild neck discomfort from sitting in one position

TMS does not usually require recovery time after a session. Many people return to work, study, driving or everyday activities afterwards, provided they feel well enough to do so. If you feel unwell, dizzy or unusually fatigued, tell the treatment team before leaving.

When side effects need attention

Although many side effects are mild, do not feel you have to simply put up with discomfort. Let the clinician know promptly if scalp pain or headaches are becoming difficult to manage, if symptoms are worsening, or if you develop a side effect that concerns you.

You should also report changes in mood or behaviour. Depression itself can involve hopelessness, agitation, sleep changes and thoughts of self-harm, and these symptoms need clinical attention whether or not you think they are connected to TMS.

Seek urgent help if you have thoughts of harming yourself, feel unable to keep yourself safe, or experience a mental health crisis. In an emergency, call 911 or go to the nearest emergency department.

The rare risk of seizure

Seizure is a rare but recognised risk of TMS. The treatment team should screen for factors that could increase this risk before beginning treatment and should review relevant changes throughout the course.

A seizure is not the same as the tapping sensation, facial movement or brief discomfort that can occur during a routine session. Clinics providing TMS should have procedures for responding to medical emergencies.

Factors that may matter to the clinician include a personal history of seizures or epilepsy, a recent seizure, a serious head injury, certain neurological conditions, substance use, severe sleep deprivation and medicines that may lower the seizure threshold. This does not automatically mean TMS is unsuitable for every person with one of these factors. It does mean that the clinician needs a full and accurate picture before deciding whether treatment is appropriate and how it should be delivered.

Do not stop prescribed medication, change a dose, or make major changes to alcohol or substance use without medical advice in order to prepare for TMS. Sudden changes can themselves create health risks.

Implants, metal and other contraindications

TMS uses a magnetic field, so implanted metal or electronic devices are an important part of the safety assessment. Tell the clinician about any device or metal in or near your head, even if you are unsure whether it is relevant.

Examples may include:

• Cochlear implants
• Implanted stimulators or neurostimulators
• Certain clips, coils or other surgical metal
• Metal fragments from an injury
• Shrapnel or retained fragments
• A history of brain surgery or neurosurgical devices

Not all metal elsewhere in the body will prevent treatment. For example, the significance of dental work, joint replacements or other medical hardware can depend on its location and type. The treatment provider should assess this individually rather than relying on assumptions.

You should also mention pacemakers, implanted cardiac devices, medication pumps and any other electronic implant. The clinician may need further information from the specialist who manages the device, or may decide that a different treatment is safer.

Pregnancy, breastfeeding, significant hearing problems and a history of bipolar disorder or mania should also be discussed. These are not matters to hide because you are worried treatment will be refused; they are details that help the clinician make an informed recommendation and plan appropriate care.

What to tell your TMS clinician

A thorough pre-treatment appointment is an opportunity to ask questions and share information. Bring a current medication list if possible, including prescriptions, over-the-counter medicines, vitamins, supplements and any recent changes.

Tell the clinician about:

• Previous TMS, electroconvulsive therapy or other mental health treatments
• Any history of seizures, epilepsy, fainting or unexplained loss of consciousness
• Head injury, concussion, stroke, brain surgery or neurological illness
• Metal fragments, implants, hearing devices or electronic medical devices
• Alcohol, cannabis or other substance use
• Major changes in sleep, especially several nights of very little sleep
• Current or previous manic or hypomanic symptoms
• Pregnancy, plans for pregnancy or breastfeeding
• New symptoms or medication changes during the course of treatment

It is also useful to explain what has and has not helped your depression in the past. TMS is normally delivered as a course of weekday sessions, often around 36 sessions over six to nine weeks. The schedule, treatment protocol and follow-up arrangements may vary, so ask how your local provider will monitor progress and side effects.

Practical safety during a treatment course

Attend sessions as planned where possible, and let the clinic know if you are unwell or cannot attend. Before each appointment, mention anything that has changed since the previous visit, including a new medication, illness, poor sleep, heavy alcohol use, a recent injury or a possible pregnancy.

You will generally be given hearing protection during treatment because the equipment makes repeated clicking sounds. Use it as instructed.

Ask the clinic who to contact outside appointment times if you are worried about a side effect. It is sensible to know whether you should call the TMS provider, your GP, prescribing clinician, an urgent care service or emergency services for different concerns.

Finding TMS information in Connecticut

TMS Therapy Connecticut currently lists 75 published clinics across the state. Directory listings include clinics in Glastonbury, Greenwich, Hartford, Milford, Fairfield, Stamford, West Hartford, Danbury, Norwich, Groton, Plainville and Farmington, among other Connecticut communities.

Practical questions can be part of safety planning too. If frequent weekday appointments would be difficult because of work, travel, caring responsibilities or transport, raise this before committing to a course. A clinic may be able to explain appointment availability and what support is available, but should not pressure you into a decision.

Insurance arrangements should also be confirmed directly with the provider and your insurer. Plans commonly encountered in Connecticut include Anthem Blue Cross Blue Shield Connecticut, ConnectiCare, Aetna, Cigna, UnitedHealthcare / Oxford, HUSKY Health, Medicare including Advantage plans, and TRICARE East. Coverage and authorisation requirements can differ between plans, even within the same insurer.

Getting help in Connecticut

Use the TMS Therapy Connecticut clinic listings to compare published local options, the insurance guide to prepare coverage questions, and the contact page for help using the directory.

This is educational information, not medical advice.