TMS Side Effects and Safety: A Wisconsin Patient Guide

TMS Side Effects and Safety: A Wisconsin 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, such as medication or talking therapy, have not brought enough improvement or have caused difficult side effects.

TMS was cleared by the US Food and Drug Administration (FDA) for major depressive disorder in 2008. In 2021, FDA clearance was expanded to include depression with comorbid anxiety. It does not involve surgery, anaesthesia or electrical current passing through the body in the way electroconvulsive therapy does.

Like any medical treatment, TMS has potential side effects and safety considerations. Most people tolerate it reasonably well, but suitability depends on individual health history, medicines and any implanted devices or metal in or around the head.

This guide explains what Wisconsin patients may wish to know before starting treatment and what information to share with a TMS clinician.

Common side effects during TMS

The most common side effects of TMS are scalp discomfort and headache. These are generally temporary and often lessen as a person becomes accustomed to treatment.

During a session, the treatment coil is placed against the scalp. The magnetic pulses can feel like tapping, knocking or a brief pulling sensation on the skin and muscles of the forehead or scalp. Some people find this uncomfortable at first, particularly during the initial sessions.

Common effects can include:

• Tenderness, pressure or discomfort at the treatment site
• Mild to moderate headache
• Facial muscle twitching during pulses
• Temporary tiredness after a session
• Temporary discomfort from the sound of the machine

A clinician can often make adjustments to improve comfort, such as changing the position of the coil or gradually increasing the treatment intensity where appropriate. It is sensible to mention discomfort early rather than trying to put up with it. The treatment team can explain what they can alter safely and what sensations are expected.

Headaches and scalp tenderness may occur shortly after treatment or later in the day. Ask your clinician whether an over-the-counter pain medicine is appropriate for you, especially if you have other health conditions or take regular medication. Do not assume that a medicine is suitable simply because it is available without prescription.

Less common effects and changes to report

People can have different responses to TMS. Although many effects are mild and short-lived, you should tell the clinic about anything that feels unusual, distressing or persistent.

For example, let the team know if you experience:

• A headache that is severe, new or does not settle
• Significant pain at the scalp or jaw
• Marked fatigue or sleep disruption
• Feeling unusually restless, agitated or unwell
• Changes in mood that concern you or those close to you
• Any new physical symptoms after a session

Depression itself can affect sleep, concentration, energy and motivation, so it may not always be clear whether a change is related to TMS, medication, life circumstances or the underlying condition. Regular check-ins with the treating clinician are important. They can review symptoms in context and decide whether treatment should continue as planned, be adjusted or be paused.

If you develop thoughts of harming yourself, feel unable to keep yourself safe, or are concerned about an urgent mental health crisis, seek immediate help through local emergency services or a crisis service. Do not wait for the next TMS appointment.

The rare risk of seizure

Seizure is a recognised but rare risk of TMS. Clinics screen for factors that may increase this risk before treatment begins and may revisit those questions during a course of care.

A seizure risk assessment may include discussion of a personal history of seizures, epilepsy, significant head injury, neurological conditions, alcohol or substance use, sleep deprivation and medicines that may affect seizure threshold. The clinician will also want to know about changes that occur after your assessment, not only what was true when you first enquired.

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

• Ever had a seizure, blackout or unexplained loss of consciousness
• Been diagnosed with epilepsy or another neurological condition
• Had a serious head injury, brain surgery or a stroke
• Recently started, stopped or changed a prescribed medicine
• Been using alcohol, recreational drugs or non-prescribed substances
• Had very little sleep or are acutely unwell

This information does not automatically mean that TMS is unsuitable. It helps the clinician decide whether treatment can be delivered safely, whether additional precautions are needed, or whether another treatment approach should be considered.

Metal, implants and other contraindications

TMS uses a powerful magnetic field. For that reason, certain metal objects or implanted devices in or near the head may make TMS unsuitable or require specialist review.

Tell the clinician about any implant, clip, plate, screw, shunt, stimulator, hearing device or other medical device. This includes items placed years ago, even if they do not currently cause problems. Details about the type, location and manufacturer may be useful where available.

Examples worth discussing include:

• Metal fragments or shrapnel in the head or face
• Cochlear implants or other implanted hearing devices
• Aneurysm clips, stents or surgical clips
• Deep brain stimulators or other implanted neurostimulators
• Implanted pumps, shunts or electrodes
• Dental work, including braces, implants or retainers
• Previous brain, ear, facial or skull surgery

Not all dental work or medical implants rule out TMS. However, the treatment provider must assess them properly. Do not rely on a general internet answer, as safety depends on the exact device and where it is located.

Pregnancy, breastfeeding, heart conditions and other physical health concerns should also be discussed with the treating clinician. A person’s wider medical situation matters when planning care, even where it is not an absolute reason to avoid TMS.

Medicines and treatment changes

Bring an up-to-date list of all medicines to your assessment. Include prescribed medicines, over-the-counter products, supplements and any occasional medicines. This should cover mental health medicines as well as treatments prescribed for pain, sleep, allergies, infections or other conditions.

Do not stop antidepressants, anti-anxiety medicines, sleep medicines or any other prescription medicine because you are considering TMS unless the clinician responsible for that medicine advises you to do so. Sudden changes can cause withdrawal effects, worsening symptoms or other safety concerns.

During a typical TMS course, which often involves around 36 weekday sessions over six to nine weeks, let the clinic know promptly if another clinician changes your medication. It is also worth mentioning major changes in sleep, alcohol intake or general health. These details can help the team reassess safety throughout treatment rather than treating the initial screening as a one-off process.

Questions to ask at a Wisconsin TMS consultation

A good consultation should give you time to discuss your history, practical needs and concerns. You may wish to ask:

• Why do you think TMS is appropriate for my symptoms?
• Are there any parts of my medical history that need further review?
• Do any of my medicines affect treatment planning?
• What sensations should I expect during and after sessions?
• What should I do if I develop a headache or scalp discomfort?
• Who should I contact outside appointment times if I have concerns?
• How will progress and side effects be monitored?
• What happens if treatment is uncomfortable or I need to miss a session?
• What costs might remain after insurance has been checked?

Insurance arrangements vary by plan, provider and clinical circumstances. In Wisconsin, patients may encounter plans from Anthem Blue Cross and Blue Shield (Wisconsin), Quartz Health Solutions, Dean Health Plan, Security Health Plan, UnitedHealthcare, Cigna, Aetna or BadgerCare Plus. A clinic can help explain its own billing process, but it is still sensible to confirm eligibility, authorisation requirements and possible out-of-pocket costs with your insurer.

Finding a clinic and preparing for treatment

TMS Therapy Wisconsin currently lists 47 published clinics across the state. Listings include clinics in Milwaukee, Waukesha, Wauwatosa, Middleton, West Allis, Glendale, Brookfield, Appleton, Racine, Wausau, Kenosha and Mequon, among other Wisconsin locations.

When comparing providers, look beyond distance alone. Ask whether the clinic carries out a full medical screening, how it handles side effects, who supervises treatment and how it communicates with your existing GP, psychiatrist or mental health professional where appropriate.

Before your first appointment, prepare a brief health summary. Include diagnoses, previous mental health treatments, medication history, allergies, surgeries, implants, seizure history and contact details for other clinicians involved in your care. Bringing this information can make the screening process clearer and safer.

Getting help in Wisconsin

Use the TMS Therapy Wisconsin clinic listings to find published providers in your area. The directory’s insurance guide can help you prepare questions for your insurer, and the contact page offers a way to get in touch with the directory team.

This article is educational information, not medical advice.