TMS Side Effects and Safety: A Oregon Patient Guide

TMS Side Effects and Safety: An Oregon Patient Guide

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate specific areas of the brain. It is most often considered for major depressive disorder when other treatments have not helped enough, have caused difficult side effects, or are not suitable for the person.

TMS was cleared by the US Food and Drug Administration for major depressive disorder in 2008, and for depression with comorbid anxiety in 2021. It does not involve surgery, anaesthesia or electrical current passing through the skull. You remain awake during treatment and can usually return to normal daily activities afterwards.

Like any medical treatment, TMS has potential side effects and risks. Most side effects are temporary and manageable, but it is important to discuss your medical history, medicines and concerns with a qualified clinician before starting.

What a TMS session feels like

During a session, a clinician positions a magnetic coil against your scalp. The coil makes clicking sounds and delivers brief magnetic pulses. You may feel tapping, knocking or a pulling sensation on the scalp.

A standard course often involves around 36 weekday sessions over six to nine weeks, although your treatment plan may differ depending on the protocol and your clinical needs. The clinician should explain what to expect, how long appointments may take and how progress will be reviewed.

TMS is generally delivered in an outpatient setting. Most people are able to drive themselves home, work, study or carry on with usual routines after a session, unless their clinician advises otherwise for an individual reason.

Common side effects

The most common side effects of TMS are scalp discomfort and headache. These are usually mild to moderate, tend to occur during or shortly after sessions, and often become easier as treatment continues.

Scalp discomfort

The treatment coil can cause localised discomfort where it rests against the head. Some people describe this as tenderness, pressure, tapping or a brief sharp sensation during pulses. The facial muscles near the treatment area may also twitch.

Tell the treatment team if the sensation is painful or difficult to tolerate. They may be able to adjust the coil position, alter aspects of the treatment setting, provide breaks or discuss other practical measures. Do not assume you must simply put up with significant discomfort.

Headache

Headache can occur after treatment, particularly in the earlier sessions. It is commonly short-lived. Your clinician can advise whether a usual over-the-counter pain medicine is appropriate for you, taking account of your other medicines and health conditions.

Seek clinical advice rather than self-managing if headaches are severe, persist, are unusual for you or occur alongside other concerning symptoms.

Other temporary effects

Some people may feel tired after a session, while others notice no change to their energy. TMS sessions can also be noisy because of the clicking produced by the magnetic coil. Hearing protection is normally used during treatment.

Depression itself can affect sleep, concentration, appetite and mood. If these symptoms change during treatment, let your clinician know. This helps them assess whether the change may be related to your underlying condition, another treatment, a medicine change or TMS itself.

Rare but important risks

The most serious recognised risk of TMS is a seizure. This is rare, particularly when treatment is delivered using appropriate screening and established safety procedures. Even so, it is a risk that should be discussed before treatment begins.

The chance of a seizure may be higher in people with a history of seizures or epilepsy, certain neurological conditions, a recent head injury, substantial sleep deprivation, heavy alcohol use or abrupt changes in alcohol or sedative use. Some medicines can also affect seizure threshold.

A history of seizures does not automatically mean TMS is impossible, but it needs careful individual assessment. Your clinician may decide that TMS is not appropriate, may seek further information from another clinician, or may recommend a different approach.

You should seek urgent medical help for a seizure, loss of consciousness, serious injury, or any new severe neurological symptoms. Clinics delivering TMS should have procedures for responding to medical emergencies.

When TMS may not be suitable

TMS is not appropriate for everyone. A key safety issue is the presence of certain metal or electronic implants in or close to the head. The magnetic field may interfere with implanted devices or cause movement or heating of some metal objects.

Examples that require careful discussion include:

• Cochlear implants
• Deep brain stimulators or other implanted neurostimulators
• Some implanted electrodes or medication pumps
• Certain aneurysm clips
• Metal fragments in or near the head or eyes
• Other implanted medical devices where magnetic exposure may be relevant

This is not a complete list. Dental fillings, braces and many forms of dental work may not prevent treatment, but you should still mention them. The clinic needs the exact details where possible, including the device type, manufacturer information, when it was implanted and the body area involved.

TMS may also need additional consideration for people who are pregnant, have significant hearing difficulties, have a neurological disorder, or have a complex mental health history. The aim is not to exclude people unnecessarily, but to ensure that treatment is appropriate and delivered safely.

What to tell your TMS clinician

Be open and thorough during screening. It is especially important to tell the clinician about anything that could affect safety, even if it seems unrelated to depression.

Share information about:

• Any previous seizure, epilepsy diagnosis, fainting episode or unexplained loss of consciousness
• Head injury, stroke, brain surgery, brain tumour or other neurological condition
• Metal in the head, face or eyes, including old injuries involving metal fragments
• Cochlear implants, stimulators, pumps, clips, electrodes or other implanted devices
• All prescribed medicines, over-the-counter medicines, supplements and recreational drugs
• Recent changes to medicines, especially those that may affect seizure risk
• Alcohol use, sedative use, or any recent reduction or withdrawal
• Major sleep loss or a pattern of severe insomnia
• Pregnancy, plans for pregnancy or breastfeeding
• Hearing problems or use of hearing aids
• Past mental health treatment, including hospital admission, bipolar symptoms, psychosis or suicidal thoughts

Bring an up-to-date medicine list to your consultation if possible. Do not stop, start or alter a medicine solely because you are considering TMS without speaking to the clinician who prescribed it.

It is also helpful to say how your depression affects daily life: sleep, work, caring responsibilities, concentration, appetite, relationships and safety. A TMS assessment should consider your wider treatment plan, not only whether you meet technical safety criteria.

Questions to ask before treatment

A good consultation gives you time to ask practical and clinical questions. You might ask:

• Why is TMS being recommended in my situation?
• Are there safety concerns based on my health history or medicines?
• What treatment protocol is proposed and how often will I attend?
• What should I do if I get a headache or scalp discomfort?
• Who should I contact between sessions if I have concerns?
• How will my mood, anxiety and side effects be monitored?
• What happens if my symptoms worsen or I develop suicidal thoughts?
• Will I continue my current medicines and talking therapy?
• What costs or insurance requirements apply to my treatment plan?

If you have urgent thoughts of harming yourself or feel unable to stay safe, seek immediate emergency or crisis support rather than waiting for a routine TMS appointment.

Practical considerations for Oregon patients

TMS Therapy Oregon currently lists 39 published clinics across the state. Directory listings include clinics in Portland, Salem, Bend, Beaverton, Roseburg, Eugene, Ontario, Corvallis, Medford, Oregon City, Tualatin and West Linn.

Availability, referral requirements, waiting times and treatment protocols can vary between providers. When contacting a clinic, ask whether it offers an assessment before treatment, how it handles safety screening, and whether it can coordinate with your GP, psychiatrist or other mental health professional.

Insurance arrangements also vary. Plans commonly seen in Oregon include Regence BlueCross BlueShield of Oregon, Providence Health Plan, Kaiser Permanente Northwest, Moda Health, PacificSource, Aetna, Oregon Health Plan through CCOs, and Medicare. Coverage is not guaranteed simply because a clinic is listed or a carrier operates in Oregon. Ask both the clinic and your insurer about eligibility, authorisation requirements, referral rules and your likely out-of-pocket costs.

Getting help in Oregon

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

This article is educational information, not medical advice.