TMS Side Effects and Safety: A Maine Patient Guide

TMS Side Effects and Safety: A Maine 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 commonly considered for adults with major depressive disorder, particularly when antidepressant 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 for major depressive disorder in 2008, and for depression with comorbid anxiety in 2021. It is delivered in a clinic while the patient is awake and seated. A standard treatment course often involves weekday appointments over around six to nine weeks, with roughly 36 sessions in total.

For many people, TMS side effects are mild and temporary. However, it is still important to understand possible risks, discuss your medical history fully, and know when to contact your treatment team.

The most common side effects

The two side effects reported most often during TMS are scalp discomfort and headache.

During treatment, the TMS coil rests against the head and produces repeated magnetic pulses. The tapping sensation can feel unusual, particularly in the first few sessions. Some people notice:

• Mild discomfort, pressure or tingling on the scalp
• A tapping or knocking feeling where the coil is placed
• Tightness in forehead, jaw or facial muscles during pulses
• A mild headache after a session
• Temporary tiredness

These effects usually lessen as treatment continues and as you become accustomed to the sensation. The clinician can often adjust the coil position, settings or treatment approach to improve comfort while maintaining an appropriate treatment plan.

A simple pain reliever may sometimes be suitable for a headache, but ask your clinician or usual prescriber before taking anything new. If headaches are severe, persistent or different from your usual headaches, tell the TMS team promptly.

TMS does not require anaesthesia or sedation. Most people can return to their normal daily activities after a session, including travelling home and going to work, unless their clinician gives different advice.

Less common effects to discuss

Some patients find that TMS is tiring, especially during the early part of a course. Others may experience temporary light-headedness, facial twitching during treatment, or discomfort around the jaw or teeth.

Treatment can be noisy because the equipment makes a clicking sound with each pulse. Clinics provide hearing protection, which should be worn throughout the session. Let the team know if you have hearing concerns, ear pain or difficulty tolerating the sound.

TMS is intended to support treatment for depression, but changes in mood should always be monitored. Tell your clinician if you notice worsening depression, increased agitation, new or escalating anxiety, unusual energy, reduced need for sleep, racing thoughts, or thoughts of self-harm. These symptoms do not necessarily mean TMS is the cause, but they need timely clinical attention.

If you have thoughts of harming yourself or feel unable to stay safe, seek urgent help through local emergency services or a crisis service rather than waiting for your next TMS appointment.

Seizure risk: rare but important

A seizure is a rare potential risk of TMS. Modern TMS protocols are designed to keep this risk low, and treatment teams screen carefully before starting. Nevertheless, patients should understand that the risk cannot be reduced to zero.

Your clinician will want to know about anything that may affect seizure risk. This can include a personal history of seizures, epilepsy, significant head injury, a neurological condition, or a previous seizure related to medicines, alcohol withdrawal or another cause.

Sleep deprivation, heavy alcohol use, recreational drug use and sudden changes to certain prescribed medicines can also be relevant. It is sensible to attend treatment well rested, avoid arriving intoxicated, and tell the clinic about significant changes in your health or medication routine.

Do not stop antidepressants, anti-anxiety medicines, sleep medicines or other prescriptions without medical advice. Some medicines may affect seizure threshold, but this does not automatically mean you cannot have TMS. Your prescriber and TMS clinician can decide whether any changes are needed.

When TMS may not be suitable

Before treatment, the clinic should carry out a detailed safety assessment. TMS is not suitable for everyone, and suitability may depend on the particular TMS system being used.

Metal or electronic devices in or close to the head are especially important to disclose. Examples may include certain clips, cochlear implants, implanted stimulators, shrapnel or other metal fragments. Some dental work and braces may be compatible with treatment, but the clinic still needs to know about them.

You should also tell the clinician if you have an implanted medical device elsewhere in the body, such as a pacemaker, defibrillator, medication pump or neurostimulator. The treatment team may need information about the device, its location and its manufacturer before deciding whether TMS can be provided safely.

A history of seizures or neurological illness does not always rule out TMS. It means that the risks need individual assessment. Similarly, pregnancy, recent surgery, chronic pain, migraine, hearing problems and significant medical conditions should be discussed rather than assumed to be barriers.

What to tell your TMS clinician

A full and accurate history helps the clinic plan treatment safely. Bring a current medication list to your consultation, including prescriptions, over-the-counter medicines, vitamins, supplements and any non-prescribed substances.

Tell the clinician about:

• Any past seizure, epilepsy, fainting episode or serious head injury
• Stroke, brain surgery, brain tumour or other neurological condition
• Metal in or near your head, including previous surgery or injuries
• Cochlear implants, implanted electrical devices or cardiac devices
• Current medicines and recent medication changes
• Alcohol use, recreational drug use, or plans to reduce or stop either
• Sleep difficulties or recent major sleep loss
• Pregnancy, breastfeeding or plans for pregnancy
• Bipolar disorder, psychosis, mania or hypomania
• Hearing difficulties, migraines, jaw pain or dental concerns
• Any worsening of depression, anxiety or suicidal thoughts

It is also useful to tell the team what has and has not helped in previous depression treatment. This includes antidepressants, psychotherapy, hospital care, ketamine-based treatment, electroconvulsive therapy or earlier TMS.

During the course, keep the clinic informed of changes. This includes a new medication, a dose change, illness with fever, missed sleep, alcohol or substance use, pregnancy, a hospital visit, or any new neurological symptoms. Do not assume a change is too minor to mention.

Questions to ask before starting

A clinic should be able to explain how it handles safety screening and side effects. You may wish to ask:

• Is TMS appropriate in light of my medical history and medicines?
• What side effects are most likely for me?
• What should I do if I get a headache or scalp discomfort?
• Who should I contact outside appointment hours?
• What happens if I miss sessions because of illness or travel?
• How will my mood and safety be monitored during treatment?
• Will my psychiatrist, GP or other prescriber be involved?

The answers should be clear and personalised. It is reasonable to take time to consider the information before consenting to treatment.

Finding treatment in Maine

TMS Therapy Maine currently lists 16 published clinics across the state. Directory listings include clinics in South Portland, Scarborough, Camden, Portland, York, Brunswick, Brewer, Falmouth and Waterville. Availability, referral requirements and treatment models can vary, so contact individual clinics to ask about their assessment process and experience with your particular medical history.

Insurance arrangements may also differ between providers. Carriers commonly seen in Maine include Anthem Blue Cross and Blue Shield, Harvard Pilgrim Health Care, Aetna, Cigna, Community Health Options and MaineCare. Coverage can depend on your plan, diagnosis, previous treatment history and the clinic’s contracting arrangements. Confirm benefits and any authorisation requirements with both the clinic and your insurer before beginning care.

Getting help in Maine

Visit the TMS Therapy Maine clinic listings to compare local options, read the insurance guide for coverage questions, and use the contact page if you need help navigating the directory.

This article is educational information, not medical advice.