What Are the Side Effects of Transcranial Magnetic Stimulation (TMS) Treatment?
I am writing this so I can share it later!
The Frontier Psychiatrists is all about efficiency. I have to write one of these a day! Today’s post will be more quotidian and less fun. It’s a brief review of the possible side effects of transcranial magnetic stimulation, or TMS, treatment. I provide this treatment at Fermata, the NYC clinic I run, and it’s provided at Acacia Clinics in Sunnyvale, CA, where I am also proud to work.
Without further ado, the side effect profile of an effective treatment for Treatment-resistant depression, Anxious Depression, Smoking Cessation, and OCD, with more indications on the way…
What are the side effects of TMS?
Transcranial Magnetic Stimulation (TMS) is a safe and effective treatment for certain mental health conditions. However, as with any medical treatment, there are potential side effects. TMS is generally well-tolerated with only a few side effects. Of those, headaches are the most common, which occur in about half of the patients receiving TMS. These usually fade during the course treatment, but over-the-counter pain relief can be taken if needed.
Additionally, some patients may experience painful scalp sensations or facial twitching, which can be reduced by adjusting the coil positioning and stimulation settings. Fatigue is also common with accelerated transcranial magnetic stimulation (multiple daily treatments). The TMS machine produces a loud noise, so earplugs are given to patients during treatment. If earplugs are not worn, temporary hearing loss can result, or even tinnitus is possible as a rare adverse effect.
It's important to be aware of the potential side effects of TMS to understand what to expect during the treatment and how to manage them. Note that side effects are most often present only during treatment, and usually do not endure past then end of the treatment. Potential side effects of TMS include:
Common Temporary Side Effects:
Headache
Fatigue
Scalp discomfort at the site of stimulation
Tingling, spasms, or twitching of facial muscles
Lightheadedness
Sleep disturbances
Improved cognition in some studies
Uncommon Side Effects:
Syncope event (fainting)
Nausea or vomiting
Hearing loss if there is inadequate ear protection (ear plugs) during treatment
Rare Side Effects:
Seizure
Tinnitus
Of note, seizure is rare:
The risk of seizure associated with TMS is extremely low. In deep TMS, the incidence of seizure is less than 1 in 30,000 (0.003%). That rate is lower with Left DLPFC stimulaiton with figure-8 coils such as those used in SAINT treatment: 1 in 250,000 treatments (0.0004%).
This rate compares favorably to the risk with oral medications:
For comparison, the rate of seizure with oral bupropion is 0.4% (40/100,000) and with SSRIs in the range of 0.1% to 4%. To further minimize this risk, we use a lower energy dose approach. With this approach, there have been no reported seizures to date, however, it remains a theoretical risk. If a patient experiences a seizure as a result of TMS, it does not mean they have epilepsy. Additionally, there are no known lasting effects from a seizure related to TMS, unless the person were to fall and sustain physical injuries.
Training with the old BrainsWay H1 coil in 2017.
The most important thing to understand is that there are no permanent changes in brain functioning as a result of transcranial magnetic stimulation, similar to one pill of a typical antidepressant. The treatment effects are potent and long lasting, however. Therefore, if there are positive changes, it is likely that these will not be permanent.
Retreatment or maintenance is likely to be necessary in the future, but with limited evidence as frequency. Retreatment is highly effective, in order to maintain the remission from symptoms achieved with the treatment.
That is my summary! Prior article about TMS include:
My Podcast Appearance on Sickboy
31% of people with OCD could be in Remission with BRAIN protocol TMS.
Depression Can Be Over In Five Days…Replicated
The Science Behind Best In Class Outcomes In Mental Health
Your Depression Should Be Over Already
The Transcranial Magentic Stimulation Podcast
A New Standard of Care for Severe Depression?
The First Line Treatment Trap In Psychiatry
Insurance Plan Requires More Studies on Parachutes: Experimental and Unproven
Could Your Depression be Over in 5 Days With SAINT?
Can You Cure Depression with this One Weird Trick?
and more…I do write a lot!