TMS is a non-invasive treatment for depression with usually mild scalp discomfort, headaches and fatigue, while rare seizure risk requires screening and safety precautions.
TMS Side Effects and Safety: A Alabama Patient Guide
Transcranial magnetic stimulation (TMS) is a non-invasive treatment that uses magnetic pulses to stimulate targeted areas of the brain. It is most often considered for major depressive disorder, particularly when other treatments have not provided enough relief or have caused difficult side effects.
TMS was cleared by the FDA for major depressive disorder in 2008, and for depression with comorbid anxiety in 2021. It does not involve surgery, anaesthesia or implanted equipment. During treatment, a clinician places a magnetic coil against the scalp while you remain awake and seated.
Like any medical treatment, TMS has possible side effects and safety considerations. Most people tolerate it well, but it is important to understand what is common, what is rare, and what information your clinician needs before treatment begins.
Common TMS side effects
The most common side effects occur around the treatment area and are usually mild to moderate. They are often most noticeable during the first few sessions, while you are getting used to the tapping sensation and the stimulation level.
Common effects include:
- Scalp discomfort or sensitivity where the coil rests
- A mild headache during or after treatment
- Tingling, twitching or tightening of facial muscles near the treatment site
- Temporary discomfort from the sound of the machine
- Feeling tired after a session, for some people
The magnetic pulses can feel like repeated taps on the head. Some people find this uncomfortable at first, especially if the stimulation intensity needs to be adjusted to reach the prescribed level. Your treatment team can often make practical changes, such as repositioning the coil, adjusting the settings within the treatment plan, or offering a short break.
Headaches are also relatively common. They are usually temporary and may settle as treatment continues. Tell the clinician if headaches are severe, persistent or different from your usual headaches. Do not simply assume that any symptom is part of treatment.
TMS clinics generally provide hearing protection because the treatment coil makes a sharp clicking sound. Wearing the supplied earplugs or other approved protection is an important part of treatment safety.
The rare risk of seizure
A seizure is the most serious recognised risk of TMS, but it is rare. TMS treatment protocols are designed to reduce this risk, and clinicians should carry out screening before starting treatment.
The likelihood of seizure may be affected by personal medical history, medicines, sleep, alcohol or drug use, and the specific treatment settings. A previous seizure does not automatically mean that TMS cannot be considered, but it does mean your clinician needs a careful, individual discussion of risks and benefits.
You should tell the clinic promptly if you have:
- A history of seizures or epilepsy
- A previous head injury, stroke or other neurological condition
- A brain tumour or a condition affecting the brain
- A family history of epilepsy, where relevant to your assessment
- Severe sleep loss or major changes to your normal sleep pattern
- Recent heavy alcohol use, alcohol withdrawal, or recreational drug use
- Changes in prescription medicines or supplements
Do not attend a session after a significant change in your health without contacting the clinic first. This includes a new seizure, fainting episode, serious illness, hospital admission, or a major medication change.
Contraindications and medical screening
TMS is not suitable for everyone. Before treatment, the clinician should ask about metal, medical devices and neurological history. The magnetic field used in TMS can interact with certain metal objects or implanted devices, particularly those in or close to the head.
You may not be suitable for TMS, or may need specialist assessment, if you have metal in or near the head that cannot safely be exposed to magnetic stimulation. Examples can include certain aneurysm clips, cochlear implants, deep brain stimulators, implanted electrodes, shrapnel or bullet fragments, and some other implanted medical devices.
Routine dental fillings, crowns and braces are not generally the same concern, but you should still mention them. The clinic needs accurate information rather than assumptions about what type of metal or device is present.
It is also important to discuss any implanted device elsewhere in the body, such as a pacemaker, medication pump or nerve stimulator. Whether TMS is appropriate may depend on the device, its location and the manufacturer’s safety guidance.
Other issues that should be discussed during screening include:
- A diagnosis of bipolar disorder, or past episodes of mania or hypomania
- Psychosis, hallucinations or severe agitation
- Pregnancy or plans to become pregnant
- Significant anxiety, panic symptoms or post-traumatic stress symptoms
- A history of substance misuse
- Chronic pain or migraine conditions
- Hearing difficulties
These factors do not necessarily prevent treatment. They help the clinician decide whether TMS is appropriate, whether extra precautions are needed, and how treatment should be monitored.
What to tell your TMS clinician
Open communication is one of the most useful safety measures you can take. Bring a current medication list to your assessment, including prescribed medicines, over-the-counter products, vitamins and herbal supplements.
Tell the clinician about medicines that have been started, stopped or had a dose change. Some medicines can affect seizure threshold, and your TMS team may need to review changes with the clinician who prescribed them. Do not stop medication on your own in preparation for TMS.
It is also sensible to tell the clinic about your usual caffeine, alcohol and recreational drug use. The aim is not to judge you; it is to identify factors that could affect safety or how you feel during treatment.
Before each session, report changes such as:
- Poor sleep or an all-night period awake
- A new or worsening headache
- Illness, fever or dehydration
- Medication adjustments
- Alcohol or substance use that is outside your usual pattern
- New medical procedures or implanted devices
- Pregnancy or a possible pregnancy
- Changes in mood, including unusually high energy, racing thoughts or impulsive behaviour
If you experience discomfort during treatment, say so at the time. The team can check the coil position and make sure the session is being delivered as intended.
Safety during a course of treatment
A standard TMS course is commonly around 36 weekday sessions over six to nine weeks. The exact schedule, type of TMS and follow-up plan can vary according to your clinical needs and the treatment provider.
Most people can return to normal activities after an appointment, though it is worth noticing how you personally respond. If you feel unwell, unusually tired or distracted after a session, ask the clinic whether you should arrange support with travel or other plans.
TMS should be delivered by trained professionals using appropriate screening and monitoring. Ask who will oversee your treatment, what happens if you develop side effects, and how to contact the clinic between appointments.
In Alabama, TMS Therapy Alabama currently lists 46 clinics. Listings include clinics in Birmingham, Tuscaloosa, Dothan, Decatur, Huntsville, Montgomery, Mobile and other communities. Availability and assessment processes can differ between providers, so confirm that a clinic can review your individual medical history before you commit to treatment.
Insurance and practical questions
Safety and suitability come first, but it is also reasonable to ask about practical arrangements. Insurance coverage may depend on your diagnosis, previous treatments and the individual plan.
Patients in Alabama may encounter plans from Blue Cross and Blue Shield of Alabama, UnitedHealthcare, Aetna, Cigna, Humana, Viva Health, Alabama Medicaid or Medicare. Coverage is not guaranteed simply because a clinic offers TMS. Ask both the clinic and your insurer about eligibility, authorisation requirements, expected out-of-pocket costs and any documentation needed from your GP, psychiatrist or other clinician.
Getting help in Alabama
Use the TMS Therapy Alabama clinic listings to find published providers across the state, review the insurance guide for practical coverage questions, or visit the contact page for help using the directory.
This is educational information, not medical advice.
This page is informational and is not medical advice.