Transcranial Magnetic Stimulation (TMS) is generally a safe and well-tolerated treatment. However, certain medical conditions and physical implants can make TMS unsafe. If you’re considering TMS therapy in Seattle, it’s important to understand the contraindications and potential risks.
Absolute Contraindications to TMS
You may not be a candidate for TMS if you have metal or ferromagnetic material in or around the head or neck, which could interact with the magnetic field. Standard dental work is safe, but any implant that is not MRI-compatible should be carefully evaluated.
Examples of contraindications include:
- Aneurysm clips or coils
- Carotid or cerebral stents
- Implanted brain stimulators or electrodes
- Ferromagnetic ear or eye implants
- Metal fragments, bullets, or shrapnel near the head (within 12 inches of the TMS coil)
- Facial tattoos with metallic ink
- Any metallic device or object implanted in the skull
If your implant is MRI-safe (e.g., titanium plate), it is typically safe for TMS as well.
TMS and Seizure Risk: What You Should Know
Although seizures from TMS are rare (less than 0.5% when following safety guidelines), they can occur during treatment. These seizures:
- Are self-limited
- Happen only during the session
- Do not lead to epilepsy
- Do not occur outside treatment (e.g., while driving)
In fact, the risk of a seizure from TMS is lower than that of many common psychiatric medications, including:
- Bupropion (Wellbutrin)
- Tricyclic antidepressants
- Some antipsychotics
A trained TMS technician will always monitor your treatment to ensure safety.
Factors That May Increase Seizure Risk During TMS
Please inform your provider if you have any of the following:
- Personal or family history of seizures or epilepsy
- Neurologic conditions (e.g., stroke, brain surgery, traumatic brain injury)
- Use of seizure-threshold-lowering medications, such as:
- Bupropion/Wellbutrin
- Stimulants
- Tricyclic antidepressants
- Antipsychotics
- Theophylline
- Recent withdrawal from alcohol, sedatives, or anticonvulsants
- Recent alcohol or recreational drug use (e.g., cocaine, MDMA)
- Severe sleep deprivation
- Excessive caffeine intake
Is TMS Still an Option If I’ve Had Seizures?
Yes — in some cases. A history of seizures doesn’t automatically exclude you from receiving TMS. If necessary, your provider may recommend low-frequency TMS over the right side of the brain. This protocol uses slower pulses (1 Hz), which inhibit brain activity rather than stimulate it, significantly reducing seizure risk.
Final Thoughts
At Clear Path Psychiatry, your safety is our top priority. If you’re unsure whether you’re a candidate for TMS, we’ll evaluate your health history, medications, and lifestyle to determine the safest and most effective treatment plan for you.
