TMS Side Effects and Safety: A Nebraska Patient Guide

TMS Side Effects and Safety: A Nebraska 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 benefit or have caused difficult side effects.

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. It does not involve surgery, implanted electrodes or general anaesthesia. During treatment, you remain awake and can usually return to normal activities afterwards.

Like any medical treatment, TMS has possible side effects and risks. Most are mild and temporary, but it is important to understand the safety screening process and to share a full medical history with the clinician before treatment begins.

Common TMS side effects

The most common side effects of TMS are scalp discomfort and headache.

During a session, the treatment coil rests against the scalp and delivers repeated magnetic pulses. Some people describe a tapping, knocking or tingling feeling around the treatment area. The scalp muscles may also twitch slightly. This can feel uncomfortable at first, especially during the first few sessions.

Headaches can occur during or after treatment. They are usually mild and often improve as a person becomes accustomed to the sessions. Your clinician may be able to adjust the coil position, treatment settings or pacing to make treatment more comfortable. They may also discuss whether a usual over-the-counter pain medicine is appropriate for you.

Other temporary effects can include:

• Tenderness at the treatment site
• Facial muscle twitching during pulses
• Tiredness after a session
• Light-headedness
• Brief discomfort from the sound of the machine

TMS equipment makes a repetitive clicking sound, so hearing protection is normally used during sessions. Tell the treatment team if the earplugs or headphones are uncomfortable, or if you have hearing concerns.

A standard TMS course commonly involves about 36 weekday sessions over six to nine weeks. Because treatment is repeated, it is useful to tell the team about side effects early rather than waiting until they become more troublesome. Small adjustments can sometimes improve comfort while maintaining the treatment plan.

Does TMS cause memory loss?

Memory loss is not considered a typical side effect of TMS. This is one reason some people ask about it when comparing TMS with other forms of psychiatric treatment.

However, depression itself can affect concentration, motivation and memory. Sleep difficulties, anxiety, medications and other health conditions may also affect thinking. If you notice new or worsening problems with memory, concentration, confusion or mood during treatment, tell your clinician. They can assess whether this may be related to your underlying condition, medicines, sleep, stress or another cause.

The rare risk of seizure

Seizure is a rare but serious risk of TMS. Modern TMS protocols include safety limits intended to reduce this risk, and clinics screen patients carefully before treatment.

A seizure associated with TMS may be more likely in certain circumstances, such as a personal history of seizures, a neurological condition, severe sleep deprivation, recent heavy alcohol use or withdrawal, or use of medicines that may lower the seizure threshold. This does not necessarily mean TMS is unsuitable, but it does mean the prescriber needs to review the situation carefully.

It is particularly important to tell the clinician if you have:

• Ever had a seizure, including a seizure in childhood
• Epilepsy or a family history of epilepsy
• A head injury, concussion or loss of consciousness
• Stroke, brain surgery, a brain tumour or another neurological condition
• Serious sleep loss or a major change in your usual sleep pattern
• Current or recent alcohol, recreational drug or substance withdrawal concerns
• Started, stopped or changed the dose of any medication

Do not make medication changes on your own in order to prepare for TMS. Instead, speak to the clinician managing your treatment, as well as the prescriber who manages your medicines where appropriate.

Metal, implants and other contraindications

Before TMS begins, the clinic should complete a safety assessment. A key part of this is checking for metal or electronic devices in or near the head.

Some implanted medical devices or metal objects may make TMS unsuitable, particularly if they are close to the treatment coil. Examples can include certain aneurysm clips, cochlear implants, implanted stimulators, metal fragments from an injury, or other implanted devices around the head or neck.

Not all metal in the body prevents TMS. For example, dental fillings, braces or metal elsewhere in the body may not be a concern. The details matter: what the device is, where it is located, and whether it is magnetic or electronically powered. Bring any information you have about an implant, surgery or device to your consultation.

You should also tell the clinician about:

• Previous brain, head, eye, ear or neck surgery
• Hearing aids, cochlear implants or chronic hearing problems
• Pacemakers, implanted pumps or neurostimulators
• Retained shrapnel, bullet fragments or workplace metal exposure
• Pregnancy, plans for pregnancy or breastfeeding
• Bipolar disorder, psychosis, mania or hypomania
• A current diagnosis of substance use disorder
• Any recent hospital admission or major medical change

Pregnancy is an individual clinical discussion. If you are pregnant, might be pregnant, or are trying to conceive, do not assume that you can or cannot have TMS without a proper review. Your TMS clinician and relevant maternity or mental health professionals can help weigh the available options.

What to tell your clinician before each session

Safety screening is not only for the first appointment. Your health and medicines can change during a treatment course, so update the team whenever something changes.

Before a session, tell the clinic if you have had poor sleep, illness, fever, a new headache, a concussion, a seizure-like event, or a significant change in alcohol or substance use. Also mention any new prescription medicines, dose changes, supplements or recreational drug use.

It can help to keep a simple list on your phone or in a notebook. Include your medications, usual doses, the name of each prescriber, allergies, previous procedures and relevant medical conditions. Bring the list to your first assessment and update it as needed.

Be open about mental health symptoms as well. Tell the clinician promptly if you experience worsening depression, agitation, unusually high energy, racing thoughts, impulsive behaviour, hallucinations, suicidal thoughts or feeling unsafe. TMS sessions are only one part of care; your treatment team needs accurate information to support you safely.

Practical safety during a course of TMS

Most people can drive themselves to and from TMS appointments, because the treatment does not usually require sedation. Still, consider your own symptoms and circumstances. If you feel unwell, very tired, dizzy or unsafe to drive, arrange another way home or speak with the clinic.

Try to maintain regular sleep, meals and hydration during the course. Consistency can also make it easier to identify whether a symptom is related to treatment, medication changes or everyday health factors.

Attend appointments as planned where possible. If you need to miss a session because of illness, travel, a medication change or another concern, contact the clinic rather than simply stopping. The team can advise on the safest next step.

Emergency symptoms require urgent help. Seek immediate emergency care if you have a seizure, severe allergic symptoms, sudden neurological symptoms, chest pain, or thoughts of harming yourself or another person. For a mental health crisis or immediate safety concern, contact emergency services or local crisis support.

Questions to ask at a Nebraska TMS consultation

A consultation is an opportunity to decide whether TMS is appropriate for you and to understand the clinic’s procedures. Useful questions include:

• What type of TMS are you recommending, and why?
• How will you assess my seizure risk and medical history?
• Are any of my medicines relevant to treatment safety?
• Do I have any implants or past procedures that need further review?
• What side effects should I report on the same day?
• Who should I contact outside appointment hours?
• How will progress, mood changes and safety be monitored?
• What should I do if I miss a session?

Nebraska patients may also wish to ask about insurance verification and prior authorisation. Plans commonly seen in Nebraska include Blue Cross and Blue Shield of Nebraska, Medica, UnitedHealthcare, Aetna, Cigna and Heritage Health, Nebraska Medicaid. Coverage decisions depend on the individual plan, referral requirements and clinical criteria, so a clinic’s billing team or your insurer can clarify your situation.

Getting help in Nebraska

TMS Therapy Nebraska lists 11 published clinics, including directory listings in Omaha, Lincoln, Fremont, Bellevue, Lexington, Kearney and Blair. Use the directory’s clinic listings to compare local options, read the insurance guide for practical coverage information, and visit the contact page if you need help navigating the directory.

This is educational information, not medical advice.