TMS is a non-invasive depression treatment with usually mild, short-lived effects such as scalp discomfort and headaches, but screening and monitoring are needed for safety.
TMS Side Effects and Safety: A Texas Patient Guide
Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate specific areas of the brain. It is commonly considered for people with depression when other treatments have not provided enough relief, or when medication side effects have been difficult to manage.
TMS does not involve surgery, electrodes placed in the brain, or a general anaesthetic. During treatment, you remain awake in a clinic chair while a coil is positioned against your scalp. Most courses involve weekday appointments over roughly six to nine weeks, often totalling about 36 sessions.
Like any medical treatment, TMS has possible side effects and risks. A careful screening appointment is an important part of making sure it is appropriate and safe for you.
Common side effects of TMS
The most common side effects are usually mild and tend to occur during treatment or shortly afterwards. Many people find that they lessen as they become accustomed to the sessions.
Common effects include:
- Scalp discomfort, pressure or tingling beneath the treatment coil
- Mild to moderate headache
- Temporary facial muscle twitching during the magnetic pulses
- Neck discomfort from sitting in one position
- Tiredness after an appointment
Scalp discomfort can feel unusual at first. The coil produces repeated tapping sensations, and some people notice tightening or twitching around the forehead, jaw or eye. Your TMS clinician can often adjust the coil position or treatment settings to improve comfort while keeping the treatment clinically appropriate.
Headaches are also common, particularly early in a course. They are generally short-lived and may respond to usual measures recommended by your clinician. Tell the treatment team if a headache is severe, lasts longer than expected, or is different from your usual headaches.
TMS sessions do not normally require sedation. Most people can return to work, study, caring responsibilities or driving afterwards, provided they feel well enough to do so. Your clinic can advise you based on your own health and treatment response.
Less common effects to discuss
Some people experience temporary changes in sleep, energy, concentration or mood during a course of TMS. Depression itself can affect these areas, so it is useful to keep your prescribing clinician and TMS team informed about any changes.
If you have bipolar disorder, or a personal or family history of mania or hypomania, mention this before treatment begins. Any treatment intended to improve depression should include monitoring for unusual increases in energy, reduced need for sleep, impulsive behaviour, racing thoughts or an unusually elevated or irritable mood.
TMS can be noisy because the coil makes clicking sounds during each pulse. Clinics provide hearing protection, which should be worn throughout the session. Tell staff if the sound feels uncomfortably loud or if you notice ringing in your ears or a change in hearing.
Anxiety about a new treatment is understandable. You can ask the clinic to explain what will happen before your first session, talk you through the initial pulses, and pause if you need a break.
The rare risk of seizure
Seizure is a rare but recognised risk of TMS. Clinics screen carefully for factors that could increase this risk and use treatment protocols designed to support safety.
A seizure is not the same as the brief facial twitching sometimes seen during treatment. Facial movement around the eye, cheek or jaw can occur because the magnetic stimulation activates nearby muscles. Your technician will be familiar with this and can make adjustments if needed.
You should tell the clinician if you have ever had:
- A seizure or epilepsy diagnosis
- A serious head injury
- A stroke or other neurological condition
- A brain tumour, brain surgery or an infection affecting the brain
- Fainting episodes that have not been assessed
- A close family history of seizures, if known
Also report anything that may temporarily raise seizure risk, such as significant sleep deprivation, heavy alcohol use, alcohol withdrawal, recreational drug use, or a recent major change in medication. Do not stop prescribed medicines suddenly in preparation for TMS unless the clinician who prescribes them tells you to do so.
If you become unwell during a course, including with fever, severe lack of sleep or withdrawal from alcohol or sedating medication, contact the clinic before your next appointment. They may need to review whether treatment should go ahead that day.
Who may not be suitable for TMS?
TMS is not suitable for everyone. The most important issue is usually the presence of certain metal or electronic devices in or close to the head, where the magnetic field could create a safety concern.
Tell the clinician about any metal, implants or devices, including:
- Metal fragments in the head or face, especially from an injury or previous work involving metal
- Aneurysm clips, coils or stents
- Cochlear implants or other implanted hearing devices
- Deep brain stimulators
- Implanted electrodes or neurostimulators
- Shrapnel or retained bullets
- Permanent metal plates, screws or other hardware in the skull or face
- A pacemaker, defibrillator or other implanted medical device
Not all metal automatically rules out TMS. For example, ordinary dental fillings and braces are often assessed differently from implanted electronic devices or metal close to the treatment area. The clinic needs accurate details of the item, where it is located and, if possible, the manufacturer or surgical records. Never assume an implant is irrelevant simply because it has been in place for years.
A screening assessment should also cover your wider medical history, including neurological conditions, heart conditions, hearing problems and current mental health symptoms.
What to tell your TMS clinician
Honest, up-to-date information helps the clinic make safe decisions. Before starting, and throughout treatment, tell the clinician about:
- All prescription medicines, over-the-counter medicines, vitamins and supplements
- Any recent medication changes, including changes to antidepressants, stimulants, sedatives or pain medicines
- Alcohol, cannabis or other drug use
- Pregnancy, plans for pregnancy or breastfeeding
- Previous psychiatric treatment, including hospital admissions or electroconvulsive therapy
- A history of psychosis, mania, hypomania or bipolar disorder
- New or worsening symptoms of depression, anxiety, agitation or suicidal thoughts
- Changes in sleep, especially several nights of very poor sleep
- New medical diagnoses, injuries or procedures
- Any implanted device or metal, even if you are unsure what it is
Bring a current medication list to your assessment. If another doctor changes a medicine during your TMS course, let the TMS team know before your next session where possible.
It is also helpful to say what side effects you are experiencing, rather than trying to “push through” discomfort. The treatment team may be able to alter practical aspects of the session, review your treatment plan or advise when to seek further medical care.
Questions to ask before treatment
A TMS consultation is an opportunity to understand both the possible benefits and the limitations of treatment. You may wish to ask:
- Why is TMS being recommended in my situation?
- Are there reasons it may not be suitable for me?
- How will my medication and mental health be monitored?
- What should I do if I miss a session or become unwell?
- Who should I contact outside appointment times if my mood worsens?
- What side effects should prompt an urgent call to the clinic or emergency services?
- Will my insurance plan require prior authorisation?
Insurance coverage varies by plan and by clinical circumstances. In Texas, patients may see plans from Blue Cross Blue Shield of Texas, Aetna, Cigna, UnitedHealthcare, Humana, Superior HealthPlan / Texas Medicaid, Medicare including Advantage plans, and TRICARE East. A clinic can help explain its billing process, but it is sensible to confirm your own benefits, referral requirements and authorisation rules directly with your insurer.
Finding a TMS provider in Texas
TMS Therapy Texas lists 443 published clinics across the state. Directory listings include clinics in major population centres and surrounding communities, including Houston, San Antonio, Austin, Frisco, Dallas, Fort Worth, Sugar Land, Round Rock, McKinney, Plano, San Marcos and El Paso.
When comparing providers, look for clear information about clinical assessment, safety screening, follow-up arrangements and who will oversee your care. It is reasonable to ask whether the clinic communicates with your GP, psychiatrist or other prescribing clinician, particularly if your medication or mental health needs are changing.
Getting help in Texas
Use the TMS Therapy Texas clinic listings to find local providers, read the insurance guide before checking cover, or 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.