If you are considering TMS therapy for depression, it is reasonable to ask a direct question: Is it safe?
You may already feel worn down by depression, medication side effects, or the uncertainty of trying another treatment. Safety is not a minor detail: it is part of making an informed, respectful decision about your care.
Transcranial Magnetic Stimulation (TMS) is a noninvasive treatment that uses magnetic pulses to influence brain circuits involved in mood regulation. Unlike electroconvulsive therapy, TMS does not require general anesthesia and does not intentionally cause a seizure. For many people with treatment resistant depression, it offers another evidence-based option among today’s depression treatment options.
At Light-tunnel Behavioral Health Services Inc. in New Haven, TMS evaluation and treatment are individualized to your psychiatric history, medical conditions, medications, and goals. Psychiatric care includes providers such as Dr. Omolola Aragbada, PMHNP.
The Short Answer: TMS Is Generally Well Tolerated
Clinical research suggests that TMS has a favorable safety profile when the appropriate device protocol, screening, and monitoring are used.
In a multisite randomized controlled trial of TMS for major depression, 4.5% of participants discontinued because of adverse events, and headache incidence did not differ significantly between active TMS and sham treatment (O’Reardon et al., 2007). This does not mean side effects never occur. It means that most reported effects are manageable and that serious complications are uncommon.
BrainsWay Deep TMS is one of the most researched TMS systems, with substantial clinical research involving its helmet-style H-coil technology. A multicenter randomized controlled trial found Deep TMS to be effective and generally safe for major depression that had not responded adequately to antidepressants (Levkovitz et al., 2015).
Common TMS Side Effects
Most people remain awake and able to communicate during treatment. You may notice sensations during stimulation, especially during the first several sessions.
Headache
A mild headache is one of the most frequently reported side effects. It may occur during treatment or shortly afterward and is often related to stimulation of scalp nerves and nearby muscles.
In the Levkovitz et al. Deep TMS trial, headache was reported in both active and sham groups, occurring in 47% of active-treatment participants compared with 36% of sham participants. This illustrates an important point: headaches can occur during the treatment experience, but they are not always caused solely by the magnetic stimulation.
Scalp Discomfort or Tenderness
The magnetic coil or helmet rests against your scalp while pulses are delivered. The sensation may feel like tapping, pressure, or repeated knocking. Some people describe temporary tenderness at the treatment site.
This discomfort often improves as your scalp and nervous system become accustomed to the stimulation. Your clinician may also adjust positioning or intensity to improve comfort.
Facial Twitching
Because facial muscles and nerves are close to the stimulation area, you may notice brief twitching around the eye, forehead, or jaw. This can feel unusual but is typically temporary.
Tell your treatment team if the twitching is painful, persistent, or especially distressing. Small changes in positioning or stimulation settings may help.
Lightheadedness
Some people experience brief lightheadedness, particularly early in treatment. Anxiety, discomfort, dehydration, or holding your breath can contribute. Sitting comfortably, eating normally unless instructed otherwise, and maintaining hydration may help.
If you feel faint, tell the clinician immediately. You should never feel pressured to continue through a symptom without reporting it.
Why Do Side Effects Often Fade After the First Week?
The first several sessions can feel like an adjustment period. Your scalp, facial muscles, and sensory system are encountering repeated stimulation, much like a tight mechanical gear being moved for the first time.
Several factors may explain why discomfort often decreases over the first week:
- Sensory habituation: Your nervous system becomes more familiar with the tapping and sound.
- Treatment adjustments: The team can refine coil placement and intensity based on your response.
- Reduced anticipatory anxiety: Knowing what to expect can make each session feel easier.
- Muscle adaptation: Nearby facial and scalp muscles may become less reactive over time.
This pattern is common but not guaranteed. If symptoms do not improve, become severe, or interfere with daily life, your provider should reassess the treatment plan.
Rare Risks You Should Understand
TMS is not risk-free. A responsible consent discussion includes rare but clinically important risks.
Seizure
A seizure is the most serious neurological risk associated with TMS, but it is rare when established safety parameters and screening procedures are followed. Risk may be higher with a personal seizure history, certain neurological conditions, abrupt withdrawal from alcohol or sedatives, sleep deprivation, or medications that lower the seizure threshold.
Your care team will review these factors before treatment. Never hide a seizure history or recent medication change.
Mania or Mood Elevation
TMS may rarely contribute to hypomania or mania, particularly in people with bipolar disorder. This is why screening for past periods of unusually elevated mood, reduced need for sleep, impulsivity, racing thoughts, or psychosis matters.
If you notice a sudden increase in energy, little need for sleep, rapid speech, risky behavior, irritability, or feeling unusually powerful or invulnerable, contact your psychiatric provider promptly. Early recognition can prevent escalation.
Hearing-Related Symptoms
TMS produces a loud clicking sound. Properly fitted hearing protection should be used during every session to reduce the risk of tinnitus or hearing changes.
Report new ringing, muffled hearing, ear pain, or sound sensitivity immediately. Existing hearing concerns do not automatically rule out treatment, but they require careful discussion and monitoring.
Who Needs Extra Screening Before TMS?
Before beginning TMS treatment in New Haven, your clinician should complete a detailed safety evaluation.
Metal or Electronic Implants
Tell the treatment team about any implant or metal near your head, neck, or upper body, including:
- Cochlear implants
- Deep brain stimulators or other neurostimulators
- Certain aneurysm clips or coils
- Implanted medication pumps
- Metal fragments, shrapnel, or bullets
- Other magnetic or electronic devices
Some dental hardware and implants far from the treatment area may not prevent TMS, but you should never assume. The specific device labeling and your medical records must be reviewed.
Seizure or Neurological History
Discuss epilepsy, unexplained fainting, prior seizures, traumatic brain injury, stroke, brain lesions, or significant neurological illness. Also provide a complete list of prescription medications, over-the-counter products, supplements, and substances.
Bipolar Disorder or Past Mania
Bipolar depression may be treated differently from unipolar major depression. Your psychiatric provider will consider your current mood state, history of mania or hypomania, mood-stabilizing treatment, and suicide risk before recommending TMS.
What Does TMS Monitoring Look Like?
Safety monitoring is not a single form you sign on the first day. It is an ongoing clinical process.
Before Treatment
Your team may review:
- Diagnosis and current depression severity
- Prior medication and therapy trials
- Bipolar, manic, psychotic, or suicidal symptoms
- Seizure and neurological history
- Metal or electronic implants
- Hearing concerns
- Current medications and recent dose changes
- Sleep, substance use, and other seizure-risk factors
During Each Session
The clinician may ask about headache, scalp discomfort, facial twitching, lightheadedness, hearing symptoms, anxiety, and mood changes. Treatment settings can be adjusted when appropriate.
Mood symptoms should also be tracked over time. Improvement is important, but so is noticing agitation, worsening suicidal thoughts, unusual energy, or signs of mood elevation.
What to Do: and What to Avoid: During TMS
Do:
- Tell your provider everything about medications, supplements, alcohol, and recreational substances.
- Use hearing protection exactly as instructed.
- Report symptoms during treatment, even if they seem minor.
- Maintain regular sleep and hydration when possible.
- Attend appointments consistently and communicate about scheduling barriers.
- Continue therapy and medication only as prescribed by your clinicians.
- Seek urgent help if your safety or ability to care for yourself changes.
Avoid:
- Stopping antidepressants, mood stabilizers, benzodiazepines, or other medications without medical guidance.
- Arriving intoxicated or withholding information about substance use.
- Ignoring new ringing in the ears, severe headache, fainting, seizure-like activity, or sudden mood elevation.
- Assuming TMS replaces emergency psychiatric care.
- Treating online testimonials as a substitute for an individualized evaluation.
TMS can be an important part of a broader treatment plan that may include therapy, medication management, psychiatric follow-up, and supportive lifestyle changes. To learn more, explore Light-tunnel Behavioral Health Services Inc.’s TMS treatment information or contact the practice to discuss eligibility and insurance questions.
Medical Safety Disclaimer and Emergency Resources
This article is for educational purposes only. It does not diagnose depression or determine whether TMS is appropriate for you. TMS must be prescribed and administered by qualified healthcare professionals after an individualized psychiatric and medical evaluation. Risks may include headache, scalp discomfort, facial twitching, lightheadedness, hearing-related symptoms, seizure, and mood elevation.
If you are in immediate danger, cannot stay safe, or may harm yourself or someone else:
- Call or text 988 in the United States to reach the Suicide & Crisis Lifeline.
- Call 911 or go to the nearest emergency department.
- Do not wait for a TMS consultation to address an urgent psychiatric crisis.
References
O’Reardon, J. P., Solvason, H. B., Janicak, P. G., et al. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: A multisite randomized controlled trial. Biological Psychiatry, 62(11), 1208–1216. https://doi.org/10.1016/j.biopsych.2007.01.018
Levkovitz, Y., Isserles, M., Padberg, F., et al. (2015). Efficacy and safety of deep transcranial magnetic stimulation for major depression: A prospective multicenter randomized controlled trial. World Psychiatry, 14(1), 64–73. https://doi.org/10.1002/wps.20199
Janicak, P. G., O’Reardon, J. P., Sampson, S. M., et al. (2008). Transcranial magnetic stimulation in the treatment of major depressive disorder: A comprehensive summary of safety and tolerability data. Journal of Clinical Psychiatry, 69(2), 222–232. https://pubmed.ncbi.nlm.nih.gov/18363421/
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