What Is TMS?
Before going in-depth regarding TMS side effects, let’s be on the same page about what TMS is.
TMS stands for Transcranial Magnetic Stimulation. It is a non-invasive method of treating depression without the use of antidepressants. It has been FDA-approved since 2008. TMS focuses on one specific area of the brain that is responsible for depression. This limits side effects because the treatment is not systemic.
Although side effects are limited in comparison to antidepressants, this does not mean TMS is free of potential challenges. Below I will discuss some of the common TMS side effects, why they occur, and how they can be addressed during treatment.
This article is for informational purposes only, and not intended to be medical advice. Inform your doctor of any complications during treatment so that adjustments can be made that fit your individual needs.
Comparing The Side Effects Of TMS To Antidepressants (3 vs. Many)
Antidepressant Side Effects
- Anorgasmia
- Agitation
- Arrhythmia (Qt prolongation)
- Blurred vision
- Blood pressure (low)
- Bruising
- Confusion
- Constipation
- Decreased Libido
- Difficulty urinating
- Diarrhea
- Drowsiness
- Dry mouth
- Dry Skin
- Erectile Dysfunction
- GI bleeding
- Headaches
- Increase pressure in the eye
- Manic episode/hypomanic episode
- Nausea
- Suicidal thoughts
TMS Side Effects
1. Fatigue
Fatigue is the most common side effect that I see as a TMS provider. In order to understand why people experience fatigue during TMS, you have to think about how it feels to go to the gym for the first time in a while. TMS is putting the brain through an intense workout.
Many people have been suffering from depression for decades, so a sudden increase in brain activity can cause soreness and fatigue the next day. Like any effective regimen though, consistency is important. With an experienced clinician that you trust and encourages you, it is expected for the exhaustion to pass gradually.
Solution to fatigue:
– Continue with treatment if you can. The best results happen for people who keep going consistently. Ideally 5 days per week.
2. Tenderness At The Location Of The Coil
One reason that TMS does not fit the definition of electroshock therapy is because TMS uses magnetic fields, not electrical fields, for the administration of treatment. The TMS magnetic field is able to penetrate the skin and skull, and then enter brain tissue without much resistance. Electrical fields would not be able to accomplish enough penetration.
A standard protocol of TMS sends 3000 pulses per session, daily (M-F), over the course of 36 treatments. As a result of these pulses, the skin can be sensitive. Thankfully, the tenderness ends after each session for most people. Each subsequent session typically gets better in terms of tolerability.
Solution to scalp tenderness:
Tylenol or another pain reliever before the appointment. This tends to work very well, especially as the intensity of pulses increases to the maximum dosage. The pain reliever might not be necessary for all 36 treatments.
3. Headache
The pulses during treatment can cause tension headaches, or prompt migraines temporarily. This is for similar reasons to why people experience fatigue and tenderness mentioned above. Headaches are usually mild to moderate and expected to pass after the first few weeks.
Solution to headaches:
Continue with treatment if you can. The best results happen for people who keep going consistently. Ideally 5 days per week. For people with a history of migraines, continue treatment as you normally would. Inform your doctor.
4-ish. The “Dips”
The “dips” are the temporary worsening of depressive symptoms during TMS treatment. It is a difficult part of treatment for some patients that I would not characterize as common, but also not unexpected. The cause may be similar to the other common TMS side effects (i.e., the increased activity of brain structures that were previously inactive).
When patients report a worsening of symptoms, the response of providers has improved. In the past, worsening of symptoms may have been brushed off or dismissed. Now it seems that providers are more able
Solution for the dips:
Continue with treatment if you can. The best results happen for people who keep going consistently. Ideally 5 days per week. Request remapping and/or adjustments if no relief after week 4.
Less Common TMS Side Effects
1. Pain
Keep in mind that there are nerves, muscles, and sinuses in the face. Depending on the anatomy of an individual, the TMS coil could be placed directly on, or adjacent to, these facial structures. In the process of targeting the brain, the magnetic pulses might also hit these structures. Depending on the nerves affected, this can be painful. There is also the possibility for vibrations to affect the sinuses. Often there might be twitching of the eye and facial muscles during treatment.
Solution for pain:
Tell your provider and ask for adjustments. There is the possibility of remapping or changing the angle of the TMS coil. The remapping or change in angle might allow the coil to avoid the problematic facial structures.
2. Tinnitus
Tinnitus is a perception of sound that does not seem to come from an external source. The sensation of tinnitus usually comes in the form of ringing or buzzing sounds. The TMS side effect of tinnitus is most likely to occur as a result of the sound of the pulses. Interestingly enough, there is evidence to suggest that TMS may be able to treat tinnitus. This is not a common side effect, but there are people who have complained about it.
Solution for tinnitus:
– Prevention is key. Wear earplugs during treatment sessions. They are usually offered by most TMS providers— at least initially. Notably, some patients do not like earplugs, so opting out of wearing them is your choice.
3. Miscellaneous Side Effects
The internet is full of testimonials that speak to the extreme benefits of TMS. There are also testimonials that speak to the negatives. I think it would be disingenuous to promote only when people have positive things to say, ignoring and not acknowledging when patients speak about the negatives. I can only speak to what I’ve seen as a provider and what the research has stated: TMS is a relatively safe and effective treatment.
If you look hard enough in the comment sections of Instagram, YouTube, Reddit, Facebook, Twitter (X), etc, you will find someone reporting their bad experience with TMS. This article stands as my acknowledgment of these individual experiences. This article also stands as my attestation that the odds of a positive outcome are overwhelmingly in favor of patients who are willing to try it. This is especially if lifestyle changes, medications, and therapy have not helped.
TMS Side Effects Summary
I am not aware of any treatments with 0 risks. Although TMS has minimized side effects, there will always be the potential for side effects to occur. You should weigh the pros and cons of trying TMS with your provider. The odds of a positive outcome are in your favor with TMS.
