TMS for depression is generally well tolerated, but patients may experience scalp discomfort, headaches or fatigue and should discuss screening and rare risks with clinicians.
TMS Side Effects and Safety: A Virginia 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 often considered for major depressive disorder, particularly when medication or talking therapy has not provided enough improvement.
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. Treatment is usually given on weekdays as a course of around 36 sessions over six to nine weeks.
For many 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.
TMS Therapy Virginia lists 79 published clinics across the state, including locations in Richmond, Vienna, Fairfax, Leesburg, Norfolk, Midlothian, McLean, Chesapeake, Fredericksburg, Staunton, Blacksburg and Stafford. Safety screening should be similar wherever you attend, but it is sensible to ask each clinic how it assesses suitability and manages side effects.
Common TMS side effects
The most commonly reported side effects of TMS are temporary discomfort at the treatment site and headache.
During treatment, the clinician places a magnetic coil against the scalp. You may feel tapping, knocking or tingling sensations on your head. Some people find the early sessions uncomfortable, especially while they are becoming used to the intensity of the pulses.
Common effects can include:
- Scalp discomfort or tenderness where the coil is positioned
- Mild to moderate headache
- Facial muscle twitching during pulses
- Temporary tiredness after a session
- A feeling of pressure around the forehead or scalp
These effects often lessen as treatment continues. Your treatment team may be able to adjust the coil position, support your head more comfortably or make gradual changes to the stimulation settings where appropriate.
Headaches are usually manageable, but do not assume you simply need to tolerate them. Tell the clinician if discomfort is affecting your ability to continue with sessions, if it is becoming more severe, or if you develop symptoms that feel unusual for you.
TMS does not involve surgery, general anaesthetic or sedation. Most people are able to return to their usual activities after a session, although it is worth considering how you personally feel before driving or returning to work.
The rare risk of seizure
A seizure is the most serious recognised risk associated with TMS, but it is rare. The magnetic pulses used in modern TMS are delivered within established safety parameters, and clinics screen patients carefully to reduce risk.
Your clinician will ask about factors that may make a seizure more likely. This does not necessarily mean you cannot have TMS, but it may affect whether treatment is suitable, how it is delivered or whether further medical advice is needed.
Factors your clinician may want to discuss include:
- A personal history of seizures or epilepsy
- Previous brain injury, stroke or neurological illness
- A family history of seizures
- Medicines that may lower seizure threshold
- Recent changes to psychiatric, sleep or other medicines
- Alcohol use, recreational drug use or withdrawal from alcohol or drugs
- Severe sleep deprivation
- Significant recent illness or fever
It is important to be open about these issues. The purpose is not to judge you or exclude you unnecessarily; it is to make the treatment as safe as possible.
If you have a seizure disorder, have had a seizure in the past, or are unsure whether an event you experienced may have been a seizure, discuss this before booking treatment. Your TMS clinician may wish to coordinate with your GP, psychiatrist, neurologist or another member of your care team.
Metal, implants and other contraindications
Because TMS uses a powerful magnetic field, certain metal objects or electronic devices may mean that treatment is not suitable. The greatest concern is metal in or very close to the head, particularly if it is magnetic or cannot be safely moved.
You should tell the clinic about any of the following:
- Metal plates, clips, coils, shrapnel or fragments in or near the head
- Aneurysm clips
- Cochlear implants
- Implanted stimulators or electronic devices
- A history of neurosurgery
- Dental work, braces or retainers
- Permanent cosmetics, tattoos or scalp treatments that may contain metallic material
- Any injury involving metal fragments, including workplace or military injuries
Not all metal elsewhere in the body prevents TMS. For example, some dental work may be compatible with treatment. The key point is that the clinic needs accurate information and may need to check the type, location and manufacturer guidance for an implant or device.
Do not rely on a general online list to decide whether you are eligible. Bring implant cards, operation records or any information you have about the device. If you have had surgery and are not sure what materials were used, tell the clinician that too.
What to tell your TMS clinician
A thorough assessment before treatment is an important part of TMS safety. Be prepared to discuss your mental health history, physical health and current circumstances.
Tell your clinician about all medicines you take, including:
- Antidepressants and other psychiatric medicines
- Sleep medicines
- Stimulants
- Pain medicines
- Medicines prescribed by another specialist
- Vitamins, supplements and herbal products
- Any recent medication changes
You should also mention alcohol, cannabis and other substance use honestly. Sudden changes in use, withdrawal, poor sleep and missed medication can matter for treatment safety.
Other useful information includes whether you are pregnant, planning pregnancy or breastfeeding; whether you have migraines or frequent headaches; and whether you have experienced mania, hypomania, psychosis or severe mood changes in the past. If you develop a marked change in mood, thoughts of self-harm, agitation or unusual behaviour during a course of TMS, contact your clinician promptly.
TMS is usually part of a wider treatment plan rather than a replacement for all other care. Do not stop prescribed medication or make major changes to it without speaking to the prescriber managing it.
Questions to ask before starting
A Virginia clinic should be able to explain its safety process in clear language. Useful questions include:
- What screening will I have before treatment starts?
- Are any of my medicines relevant to TMS safety?
- Do my implants, dental work or past surgeries need further checking?
- What should I do if I have a headache or scalp pain after a session?
- Who is available if I have a concern between appointments?
- What happens if I miss sessions because of illness, travel or a medication change?
- How will you communicate with my psychiatrist, GP or other clinician if needed?
It may also be helpful to ask about payment and cover before committing to a course. Insurance arrangements differ by plan and provider. In Virginia, patients may encounter cover through Anthem Blue Cross and Blue Shield, UnitedHealthcare, Aetna, Cigna, Virginia Premier, Molina Complete Care, Virginia Medicaid (Cardinal Care) or Medicare. A clinic can explain its own billing process, but you should confirm benefits, authorisation requirements and possible out-of-pocket costs directly with your insurer.
When to seek urgent help
Contact your treatment team promptly if you experience severe or worsening headaches, fainting, confusion, a seizure, or symptoms that concern you after treatment.
Seek urgent medical help if you are at immediate risk of harming yourself or someone else, or if you have severe neurological symptoms. TMS clinics provide scheduled treatment, but they are not a substitute for emergency care.
Getting help in Virginia
Use the TMS Therapy Virginia directory’s clinic listings to find published providers across Virginia, including the 79 clinics currently listed. Review the insurance guide for information to discuss with your insurer, and use the contact page if you need help navigating the directory.
This article is educational information, not medical advice.
This page is informational and is not medical advice.