TMS is an outpatient depression treatment generally tolerated with temporary scalp discomfort and headaches, while clinicians assess individual risks, including rare seizures.
Understanding TMS safety
Transcranial magnetic stimulation, usually shortened to TMS, is a non-invasive treatment that uses magnetic pulses to stimulate specific areas of the brain. It is delivered while you are awake, typically in an outpatient clinic. A standard treatment course often involves weekday sessions over about six to nine weeks.
TMS was cleared by the FDA for major depressive disorder in 2008. In 2021, FDA clearance was extended to depression with comorbid anxiety. As with any medical treatment, the right choice depends on your symptoms, health history, medicines and previous treatment experience.
Most people tolerate TMS well. Side effects are usually mild, tend to occur during or shortly after treatment, and may lessen as treatment continues. Your clinician should discuss possible benefits, limitations and risks before you begin.
Common side effects
The most common side effects of TMS are discomfort on the scalp during treatment and headache afterwards.
During a session, you may feel tapping, knocking or tingling on the scalp where the magnetic coil is placed. Some people describe the sensation as uncomfortable at first, particularly while the treatment intensity is being adjusted. The treatment team can often make practical changes, such as repositioning the coil or adjusting settings within the treatment plan, to improve comfort.
Headache can occur during the early part of a course. It is generally mild and temporary. Tell the clinic if a headache is severe, persistent or different from your usual headaches. They can advise you about suitable next steps, including whether an over-the-counter pain medicine may be appropriate for you.
Other temporary effects may include:
- Tenderness or irritation of the scalp at the treatment area
- Facial muscle twitching during the magnetic pulses
- Tiredness after a session
- Light-headedness or discomfort from sitting in one position
TMS sessions can be noisy because the device makes clicking sounds as pulses are delivered. Clinics normally provide earplugs or other hearing protection. Use this protection as instructed and tell the team if you have hearing concerns or find the sound uncomfortable.
Side effects should not simply be endured. Let staff know at the time if treatment is painful, if you feel unwell, or if a symptom is affecting your ability to continue with normal activities. Your treatment team needs accurate feedback to provide care safely.
The rare risk of seizure
Seizure is a rare but important risk of TMS. A seizure is a sudden burst of abnormal electrical activity in the brain that can cause changes in awareness, movement or sensation. TMS clinics screen for factors that could increase this risk before treatment begins.
The clinic will usually review whether you have ever had:
- A seizure or epilepsy diagnosis
- A significant head injury
- A stroke or other neurological condition
- Brain surgery
- A brain tumour or other structural brain condition
- Severe sleep deprivation or recent major changes in sleep
- Heavy alcohol use, withdrawal from alcohol, or use of recreational drugs
- Medicines that may affect seizure risk
Having one of these factors does not automatically mean you cannot have TMS. It does mean your clinician needs to assess the situation carefully and decide whether TMS is suitable, whether further medical advice is needed, or whether treatment settings and monitoring should be adjusted.
It is particularly important to tell the clinic about changes that happen during a course of treatment. For example, let them know if you have started or stopped a medicine, have been sleeping very poorly, have become unwell, or have changed your alcohol or substance use. These details may affect safe treatment planning.
Implants, metal and other screening questions
TMS uses a magnetic field. For this reason, the clinician will ask about metal or implanted devices in or near your head.
Some forms of metal or electronic implants may make TMS unsuitable, especially if they are close to the treatment area. Examples can include certain implanted stimulators, cochlear implants, clips, pumps or other devices. The clinic may need details about the manufacturer, model and location of an implant before making a decision.
Do not assume that an implant is irrelevant because it was placed many years ago, or because it is not currently causing symptoms. Bring any available information, such as an implant card, operation record or device details. If you are unsure whether you have metal or an implanted device, say so.
Routine dental fillings and many dental restorations are commonly discussed during screening, but the clinic should assess your individual circumstances. It is also sensible to mention previous facial, jaw, eye, ear, neck or brain surgery.
A careful screening appointment is not a formality. It helps the clinician identify circumstances where TMS may need further review, a different approach or may not be advised.
What to tell your clinician
Be open with the clinician carrying out your assessment and with staff delivering each session. TMS safety depends partly on accurate information.
Before treatment, tell them about:
- Current medicines, including antidepressants, sleeping tablets, pain medicines, stimulants and medicines prescribed by other specialists
- Vitamins, supplements and herbal products
- Any history of seizure, fainting, concussion, head injury or neurological illness
- Alcohol use and recreational drug use
- Hearing difficulties, tinnitus or use of hearing devices
- Metal, implants, pacemakers, pumps or devices placed in the head, neck or elsewhere
- Pregnancy, plans for pregnancy, or breastfeeding
- Previous experience of TMS, electroconvulsive therapy or other mental health treatments
- Allergies and other significant medical conditions
During treatment, tell the team if you experience a new or worsening headache, marked scalp pain, dizziness, a change in vision or hearing, unusual movements, confusion, or any symptom that concerns you. Seek urgent medical help for severe or sudden symptoms rather than waiting for your next appointment.
You should also tell the clinician about changes in your mental health. This includes worsening depression, agitation, thoughts of self-harm or suicide, or a major change in mood. TMS is one part of a wider care plan, and your team needs to know how you are managing between sessions.
Practical safety during a course of TMS
Attend appointments rested where possible, eat and drink as you normally would unless the clinic gives different instructions, and use the hearing protection provided. Keep a current list of your medicines and update the clinic whenever a prescriber changes a dose or adds a new treatment.
Do not stop prescribed medicines suddenly because you are beginning TMS unless the clinician who prescribed them has advised this. Stopping some medicines abruptly can cause withdrawal effects or make symptoms worse.
Ask the clinic what to do if you miss a session because of illness, travel or another commitment. A missed appointment does not necessarily end a treatment course, but the team should guide you on how the schedule may be adjusted.
Finding a Michigan TMS clinic
TMS Therapy Michigan currently lists 55 published clinics. Directory listings include clinics in several parts of the state, including Grand Rapids, Lansing, Troy, Southfield, Detroit, Grandville, Flint, St. Clair Shores, Brighton, Okemos, East Lansing and Bloomfield Hills.
Availability, referral requirements and clinical screening processes can vary. When contacting a clinic, ask who will assess your medical history, how side effects are monitored, what happens if you feel unwell between sessions, and how the clinic communicates with your GP, psychiatrist or other treating professionals where appropriate.
Insurance arrangements also vary. Michigan patients may encounter coverage through carriers such as Blue Cross Blue Shield of Michigan, Priority Health, Molina Healthcare of Michigan, McLaren Health Plan, UnitedHealthcare, Aetna, Michigan Medicaid and Medicare. Coverage is not guaranteed, and prior authorisation or other requirements may apply. Confirm both clinical suitability and financial arrangements directly with the clinic and your insurer.
Getting help in Michigan
Use the TMS Therapy Michigan clinic listings to explore local options, read the insurance guide for general coverage information, and visit the contact page if you need help using the directory.
This article is educational information, not medical advice.
This page is informational and is not medical advice.