Understanding and Addressing Potential Side Effects of TMS

What is TMS Therapy?

Rare But Severe Side Effects

While rare, TMS therapy may also be associated with more severe side effects that require immediate medical attention. These include:

Seizures: Although extremely rare, TMS therapy has been associated with seizures in some patients, particularly those with a history of epilepsy or other seizure disorders. It's important to note that in the rare event a patient experiences a seizure during a TMS session, they do not become epileptic moving forward. Additionally, the seizure would only occur during the TMS session, and it would happen in a safe environment in the office, not while the patient is driving or operating machinery. Patients at risk for seizures should be closely monitored during TMS sessions.

To put this into perspective, the well-known and commonly used antidepressant bupropion (aka Wellbutrin) is known to cause seizures and estimated frequency, when daily doses are below 300 Mg, is estimated at 0.1% but increases to 0.4% with doses up to 450 mg daily (1). Different reports have estimated different frequency of TMS-induced seizures. For example, Rossi et al estimated it to be <1/30,000 (<0.003%) (2). The generally accepted statistic for TMS-induced seizures is less than 1% (3). On the other hand, my friend and mentor Dr John O’Reardon (click here for picture with Johnny) who has been doing TMS for 3 decades and whose research lead to FDA approval of TMS in 2008, tells me has never seen a TMS-induced seizure when he was at Penn Medicine (https://www.med.upenn.edu/tms/) nor in his private practice (https://www.johnoreardonmd.com/).

Hearing Loss: I have never seen this happen, but there are reports of TMS therapy causing temporary hearing loss or tinnitus due to the noise it causes. Again, to put this into perspective, a TMS system is less noisy than your regular blow dryer or blender in your kitchen. In any case, all patients are provided with ear plugs to avoid discomfort.

In addition to potential side effects, it's essential to consider other factors associated with TMS therapy:

1. Commitment: While not a side effect per se, TMS therapy requires commitment. Patients need to come to the office on a daily basis for several weeks. This can be tiring in and of itself, but is essential for optimal treatment outcomes.
2. Discomfort During Sessions: Another consideration is the discomfort some patients may experience from sitting still on the TMS chair for 20-30 minutes at a time. To address this, patients are encouraged to bring a cushion or pillow to support their backs or necks, and enhance their comfort during sessions.
3. Comparison to Tattoo Sensation: Anecdotally, some patients compare the sensation of TMS to that of getting a tattoo. However, I’ve been told by my patients with tattoos that TMS therapy was less painful or uncomfortable than getting a tattoo.

In conclusion, TMS therapy offers significant benefits for individuals struggling with depression and other conditions. If you are considering TMS, it's important that you are aware of the potential side effects and take steps to address them effectively if they occur. By understanding the nature of such side effects I hope you will feel more confident when and if you decide to give TMS therapy a chance to help you get where you need to be. If you are local to Wilmington Delaware, we can help.