Feeling tired during transcranial magnetic stimulation is one of the most common questions we hear from patients, and it is a fair one to ask. Many people who come to us have already lived through years of depression, medication trials, and side effects that made daily life harder rather than easier. Before committing to another treatment, they want an honest picture of what TMS may feel like, what can go wrong, and what to do if it does. At NeoPsych in Glendale, Dr. Thomas Hughes and our clinicians believe that a clear, balanced conversation about side effects is part of good care, not a barrier to it. Some people search phrases like “TMS ruined my life” because they have read difficult stories online, and those experiences deserve to be taken seriously rather than brushed aside.
What TMS Is and Why Side Effects Can Happen
Transcranial magnetic stimulation, or TMS, is a non-invasive treatment that uses a magnetic coil placed against the scalp to deliver brief, focused pulses to areas of the brain involved in mood regulation. The magnetic field passes through the skin and skull and gently stimulates nerve cells near the surface of the brain, which in turn communicate with deeper networks linked to depression and anxiety. Unlike antidepressant medication, TMS does not circulate through the bloodstream, so it does not typically cause systemic effects such as weight gain, sexual side effects, or nausea. Patients are awake throughout each session, no anesthesia is needed, and most people drive themselves to and from their appointments. You can read more about how the process unfolds on our TMS therapy overview page.
Because TMS acts locally, its side effects tend to be local as well, along with a few that patients describe as more general. The repeated pulses stimulate not only brain tissue but also the scalp, nerves, and muscles beneath the coil, which helps explain why tenderness and headache are so frequently reported. A standard course at NeoPsych involves daily sessions, Monday through Friday, for a total of roughly 36 treatments, so the body is adjusting to something new on a regular schedule. Accelerated protocols deliver many sessions in a shorter span of days, which can make short-term side effects more noticeable for some patients. Understanding these mechanisms does not erase discomfort, but it often makes the experience feel more predictable and less alarming.
Does TMS Make You Tired? Fatigue and Other Common Concerns
Side effects are personal, and two people receiving the same protocol may describe very different experiences. Some notice nothing beyond a mild tapping sensation, while others need several sessions before treatment feels comfortable. The concerns below are the ones we discuss most often with patients in Glendale and across LA, and each one deserves a thoughtful answer.
Fatigue
Yes, TMS can make some people feel tired, particularly during the first one to two weeks of treatment. In his clinical experience, Dr. Hughes has found fatigue to be one of the most frequently mentioned side effects, and he often compares it to returning to the gym after a long break: the brain is being asked to work in a new way, and a sense of next-day heaviness or mental tiredness can follow. The precise reasons are not fully understood, and several factors likely overlap, including the daily treatment routine, commuting, changes in sleep, the emotional work of recovery, and the exhaustion that depression itself so often causes. For most patients, this tiredness eases gradually as treatment continues. If fatigue is severe, persistent, or interfering with your safety at work or on the road, we want to know right away so we can adjust your plan.
Headache
Headache is among the most consistently reported side effects in TMS research. In the large THREE-D randomized trial published by Blumberger and colleagues in The Lancet in 2018, headache was the most common treatment-related adverse event, reported by about two-thirds of participants in both the standard 10 Hz group and the theta burst group. These headaches are usually mild to moderate, often resemble tension headaches, and tend to become less frequent after the first week or two. Patients with a history of migraine can generally continue treatment, though we ask them to share that history with us so we can plan ahead.
Scalp Discomfort
Many patients notice a tapping or tingling sensation under the coil, and some feel tenderness at the treatment site during or shortly after a session. This sensation is related to stimulation of the scalp and superficial muscles rather than any injury to the brain. International safety guidelines published by Rossi and colleagues in Clinical Neurophysiology in 2021 describe local discomfort and headache among the minor, transient effects of TMS. In practice, scalp sensitivity usually improves as sessions continue and the body acclimates, and an over-the-counter pain reliever taken before an appointment is often helpful when appropriate for the individual patient. Many patients are comfortable enough during treatment to listen to music, watch tv, or meditate.
Seizure Risk: Rare but Important
The most serious known risk of TMS is a seizure during stimulation, and it is understandable that this possibility weighs on people. The evidence suggests the risk is very low when treatment follows established safety guidelines. In a survey of laboratories and clinics covering more than 318,000 TMS sessions, Lerner, Wassermann, and Tamir reported in Clinical Neurophysiology in 2019 that TMS delivered within published guidelines to individuals without recognized risk factors was associated with fewer than one seizure per 60,000 sessions. The same study found that risk factors such as epilepsy or brain lesions increased risk substantially, and that seizures were most likely within the first few exposures. This is why careful screening matters so much, and why we review your medical history and medications before any treatment begins.
When Experiences Go Beyond the Common List
Some patients describe effects that appear less often in brochures, such as a temporary worsening of mood, increased anxiety, insomnia, or feeling emotionally unsettled. Dr. Hughes has written candidly about these experiences in our article TMS Ruined My Life?, and about the temporary symptom worsening some people experience in our guide to the TMS dip. These experiences are real, and they should never be dismissed as being “all in your head.” Anyone with a personal or family history of bipolar disorder should discuss it before starting, since mood elevation is a recognized consideration with antidepressant treatments of many kinds. Our role is to listen closely, monitor carefully, and change course when something does not feel right.
How We Customize Care to Reduce Side Effects
At NeoPsych, our Signature TMS approach is built around close physician involvement. Dr. Hughes is present at every TMS appointment in Glendale, which allows him to hear about side effects as they happen and make real-time adjustments rather than waiting for a scheduled review. This level of direct access is a meaningful difference for patients who are anxious about how their body will respond, and it allows our clinicians to respond quickly when something changes.
Adjusting the Treatment Itself
Several elements of treatment can be tailored to improve comfort. Stimulation intensity can be increased gradually over the first sessions so the scalp has time to adapt, and the coil position can be fine-tuned when discomfort is concentrated in one area. We offer standard TMS as well as accelerated TMS protocols, and targeting options range from traditional scalp-based mapping to 3D-guided positioning and optional fcMRI-guided targeting. For patients who are especially sensitive to side effects, a slower pace may be the better choice; for example, our 10-day accelerated protocol spreads sessions over two weeks to allow more recovery time between treatments.
Screening and Who May Not Be a Good Fit
Safety screening is folded into every consultation. TMS is generally not appropriate for people with metal implants in or near the head, certain implanted medical devices, or an unmanaged seizure disorder. We also ask about pregnancy, recent medication changes, substances that may lower the seizure threshold, sleep deprivation, and any history of mania or hypomania. Patients who have tried antidepressants or psychotherapy without sufficient relief are often well-suited for TMS, while others may benefit more from medication management or a referral to a trusted therapist within our network. If TMS is not the right fit, we will say so clearly and help you explore other options.
What to Expect During and After Treatment
Most side effects of TMS are front-loaded, meaning they tend to be most noticeable in the first several sessions and then fade. Tenderness typically resolves shortly after each session, headaches often become less frequent after the first one to two weeks, and fatigue usually lifts gradually as the routine becomes familiar. Patients commonly read, listen to music, or simply rest during sessions, and most return to work or daily responsibilities the same day. Hearing protection is offered during treatment because the coil produces a loud clicking sound.
Improvement in mood, sleep, or energy often begins within two to four weeks of standard treatment, although timelines vary from person to person. It can feel discouraging to experience tiredness before you notice benefits, and we encourage patients to share those feelings openly rather than pushing through in silence. Consistency matters, and patients who complete their full course tend to give themselves the best chance of meaningful change. Throughout treatment, we track symptoms, review side effects at each visit, and adjust the plan as needed.
Practical Ways to Manage Tiredness During TMS
Small habits can make a noticeable difference in how energized you feel during a course of TMS. Prioritizing consistent sleep and wake times, staying hydrated, and eating a balanced meal before appointments can help steady energy levels. Gentle movement such as a short walk after sessions may also ease the heavy feeling some patients describe. If your schedule allows, plan lighter workloads during the first week or two of treatment, when side effects are most likely.
It is also wise to be mindful of caffeine, alcohol, and any new supplements, and to tell us about any medication changes before your next session. If you plan to drive, take a moment after your session to check in with how you feel, and arrange a ride if you are unusually drowsy. Our detailed article on why TMS side effects occur and how to address them offers additional suggestions from Dr. Hughes. Above all, keep us informed, since even a minor adjustment to timing or intensity can help.
A Note on Safety and Crisis Support
Fatigue and discouragement can feel heavier when you are already living with depression. If you notice thoughts of suicide or self-harm at any point before, during, or after treatment, please tell us right away and seek immediate support. You can call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day, or call 911 in an emergency. Reaching out is a sign of strength, and you do not have to manage these feelings alone.
Schedule a Consultation at NeoPsych in Glendale
If you are considering TMS but feel uncertain about side effects, a conversation with Dr. Thomas Hughes can help you weigh the benefits and risks in light of your own history. You can learn more about his training and philosophy on the Meet Dr. Hughes (https://neopsych.com/meet-dr-hughes/) page. During your consultation, we will review your symptoms, past treatments, and medical background, answer your questions about fatigue, headache, and safety, and help you decide whether standard or accelerated TMS makes sense. Our office is located at 1510 S Central Avenue, Suite 615, in Glendale, and both in-person and virtual consultations are available. When you are ready, you can contact NeoPsych or call (213) 433-2823 to schedule a visit with our team.