Is TMS for depression a safe option? The internet says yes AND no.
If you are searching online for information about TMS for depression, you are likely looking for both the benefits and side effects of the procedure. The drawback to looking online for information is that the majority of perspectives tend to be on the extreme (positive and negative), with few nuanced perspectives. For instance, searching “TMS ruined my life” can give some alarming results. Some of these websites may be dedicated to discrediting TMS. On the opposite end of that spectrum, you are likely to hear about how beneficial the procedure is. In this blog I hope to offer commentary on the procedure from a provider’s perspective, one that acknowledges the benefits and side effects of the procedure. There is also additional information that can be found here.
Side Effects of TMS
The most common side effects of TMS are 1) tenderness at the spot of the coil placement, 2) headache, and 3) fatigue. The most severe side effect is seizure during treatment. To reiterate, a seizure is the most severe, not the most common side effect. In fact, the risk of seizure has been found to be less than 1% in most studies. Furthermore, patients with a history of epilepsy are most at risk for this.
The less common side effects of TMS tend to be discussed in aforementioned online forums amongst patients, or on anti-TMS websites. These reported side effects may include, but are not limited to:
- Manic episode (if the person has undiagnosed Bipolar Disorder)
- Memory loss
- Worsening depression “dip”
- Worsening anxiety
- Insomnia
- Dissociation
Why Don’t Doctors Speak More About the Less Common Side Effects of TMS?
Yes, it is possible for these side effects to occur, and should not be ignored or dismissed as, “just in your head.” I have personally seen people experience what is referred to as a “dip” (temporary worsening symptoms of depression) during the early stages of treatment. The cause of a “dip,” like the other less common side effects, is unclear. The people I have treated recovered and ended treatment feeling much better compared to when they started.
Not listing every possible side effect is probably not intentionally deceptive. More likely, TMS providers are attempting to present the risks and benefits in a digestible way. Most people would agree that hearing the long list of medication side effects on tv advertisements is overwhelming, so could you imagine if a doctor listed every possible side effect to all medication options? The same may be the case for TMS.
This blog stands to acknowledge that rare side effects can occur, but also to highlight the chances of relief from depression are much more likely to occur.
Now that we have discussed the risks, let’s discuss the benefits.
Benefits of TMS
The results that I have seen performing TMS for depression have been amazing. After completing hundreds of sessions, I can attest to seeing patients who finished treatment and felt like completely different people. Some of the most common benefits from TMS include, but are not limited to:
- Improved sleep
- Less negative ruminating thoughts
- Improved focus/concentration
- Decreased suicidal thoughts
- Decrease in Generalized Anxiety
The most frequent reason people request a TMS consult from me is due to psychiatric medications that are totally ineffective, partially effective, or effective with intolerable side effects. I have not seen any of the typical medication side effects with TMS. Some complaints about psychiatric medication include, but are not limited to:
- Increased blood pressure
- Sexual side effects
- Dizziness
- Confusion
- Blurry vision
- Malaise
If TMS is Relatively Safe, What Else Should I Know?
The initial phase of TMS can be uncomfortable because it takes time for the scalp to get used to the magnetic pulses. After that, people are comfortable enough to watch their favorite TV shows or movies during their sessions.
TMS treatment requires a commitment, but many have found it to be worth the effort. Treatment recommendations are to complete one session per day for a total of 36 treatments, Monday-Friday. Each session takes about 20-30 minutes with no need for anesthesia. People are able to drive to and from their appointments. There is also no need to take time off work. Side effects, if they occur, usually pass after the first 2 weeks.
“TMS Ruined My Life” Summary
If you go on the website of a TMS provider, the 3 most common side effects are readily mentioned: tenderness, headache, and fatigue. The most concerning side effect, seizure, may also be mentioned. The less common side effects — probably not mentioned at all, even on highly respected websites (example).
Everyone responds to treatment differently. Doctors are able to predict the benefits and risks of these treatments for the average person, but there will always be outliers. I encourage the readers of this blog to be skeptical of anyone who proclaims TMS to be 100% safe or 100% dangerous. Neither of those claims are correct.
I encourage everyone to carefully think about how they would like to address their symptoms of depression. I hope this blog offers transparency to detractors, advocates, and everyone in between. If you have more questions, feel free to contact us or click here to request more information.
