Safety & Side Effects of TMS Part 5:The Importance of Proper Patient Screening

---

---

One of the most important steps in providing safe and effective Transcranial Magnetic Stimulation (TMS) therapy happens before the first session even begins. This step is known as patient screening, and it’s how clinicians make sure that each person is a good fit for treatment. Thorough screening doesn’t just keep patients safe—it also increases the chances of success by helping providers tailor the experience to each person’s unique needs and medical history.

Why Screening Matters

Although TMS is non-invasive and has a strong safety record, it still involves electrical activity in the brain. That means certain risk factors—like a history of seizures, certain implanted devices, or unmanaged psychiatric symptoms—could increase the chance of complications.

Proper screening allows the treatment team to identify contraindications (such as epilepsy or metal implants), adjust the treatment plan for patients with special considerations (like bipolar depression or anxiety), and build trust by educating the patient about how TMS works and what to expect. Skipping or rushing this step could lead to unsafe treatment or poor outcomes—something no reputable clinic would risk.

What’s Covered in a TMS Screening?

A thorough TMS screening is like a health detective checklist—it gives the provider a complete picture of your brain, body, and background before starting treatment. It’s designed to rule out anything that might raise your risk and to customize the therapy for your needs.

Here’s what’s typically included:

1. Neurological History

Clinicians ask about any history of:

• Seizures (including febrile seizures in childhood)
• Epilepsy or seizure-like activity
• Traumatic brain injury (TBI) or concussion
• Neurological diseases like multiple sclerosis, Parkinson’s disease, or brain tumors

Even if these conditions are in the past, they can still influence your brain’s response to TMS and must be considered when deciding how to proceed.

2. Psychiatric History

You’ll be asked about your:

• Diagnoses (such as depression, anxiety, PTSD, OCD, or bipolar disorder)
• Medication history, including what has or hasn’t worked
• Hospitalizations or suicide attempts
• Manic or hypomanic episodes, even if you were never officially diagnosed with bipolar disorder
• Current symptoms, like severe hopelessness, panic attacks, or dissociation

This part of the screening helps your provider assess whether you’re emotionally stable enough to start TMS and whether adjustments to the protocol might be needed.

3. Substance Use History

You’ll be asked about:

• Recent or current alcohol or drug use
• History of stimulants or benzodiazepine abuse
• Withdrawal symptoms from substances like alcohol, opioids, or Xanax
• Caffeine intake and use of energy drinks

This is essential because substance use can lower your seizure threshold and affect brain activity. Even something that seems harmless, like daily pre-workout powders, can increase your risk during TMS if not properly disclosed.

4. Implants, Hardware, and Metal Screening

The team will review any:

• Head or neck surgeries
• Shrapnel injuries, bullet fragments, or facial implants
• Cochlear implants, deep brain stimulators, or pacemakers
• Orthodontic work, which is generally safe but still noted

If you’ve had any kind of implant or metal placed in your body—especially above the shoulders—this must be reviewed to ensure it’s non-ferromagnetic and won’t be affected by the magnetic pulses. In some cases, your provider may request surgical records or radiology reports for confirmation.

5. Medication Review

Not all medications are risky with TMS, but certain ones are flagged for extra attention:

• Bupropion (Wellbutrin) and tramadol can lower seizure threshold
• Stimulants like Adderall or Ritalin may increase brain excitability
• Mood stabilizers, antipsychotics, or sleep medications may influence how your brain responds

Your full medication list—including supplements and over-the-counter products—is reviewed to look for interactions, risks, or opportunities to boost outcomes.

6. Physical and Functional Readiness

Even non-invasive treatments like TMS require a little cooperation. Providers check for:

• Ability to sit still for 20–40 minutes
• Neck and posture limitations
• Uncontrolled physical tics, movement disorders, or severe pain
• Pregnancy status (not a strict contraindication, but still noted)

If someone struggles with staying still or has high levels of discomfort, the provider might adjust the coil positioning, schedule shorter sessions, or use padding for support.

Communication is Key

Good screening is more than just checking boxes—it’s about having honest conversations. Patients should always feel encouraged to share their full history, even if they’re unsure whether something is relevant. It’s much better to flag a possible concern early than to find out mid-treatment. For example, a patient might not realize that an old shrapnel fragment from a childhood injury could disqualify them until they mention it. Another may have forgotten to list a past manic episode until asked specifically. By openly discussing the details, the provider can give the most accurate guidance and prevent avoidable risks.

Tailoring Treatment to the Patient

In some cases, screening doesn’t rule someone out from receiving TMS—it simply changes how the treatment is delivered. Patients with a history of sensitivity may start with lower stimulation intensities, while individuals with co-occurring anxiety may benefit from shorter sessions or adjusted schedules. Those with mild cognitive concerns may receive added support, like memory check-ins or slower ramp-up protocols. This is where screening becomes part of personalized medicine—using the patient’s background to create a plan that’s safer, more effective, and more comfortable.

Final Thoughts

TMS is only as safe as the care team that delivers it. And great care starts with great screening. By thoroughly reviewing medical history, understanding patient needs, and keeping open communication, providers can ensure that TMS therapy is delivered as safely and successfully as possible.

Whether someone is seeking relief from depression, OCD, or anxiety, the screening process is the foundation that helps them take the first step with confidence.

Sources

1. McClintock, S. M., Reti, I. M., Carpenter, L. L., et al. (2018). Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. Journal of Clinical Psychiatry, 79(1), 16cs10905. https://doi.org/10.4088/JCP.16cs10905
2. Rossi, S., Antal, A., Bestmann, S., et al. (2021). Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Clinical Neurophysiology, 132(1), 269–306. https://doi.org/10.1016/j.clinph.2020.10.003
3. Lefaucheur, J. P., André-Obadia, N., Antal, A., et al. (2014). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clinical Neurophysiology, 125(11), 2150–2206. https://doi.org/10.1016/j.clinph.2014.05.021
4. George, M.S. and Aston-Jones, G. Noninvasive (2010) techniques for probing neurocircuitry and treating illness: Vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Neuropsychopharmacology, 35, 301-316. https://www.scirp.org/reference/referencespapers?referenceid=28846

Locations

Choose the office that’s most convenient for you. Our Chesterfield and Richmond Heights locations are here to provide accessible, patient-focused care in a welcoming and professional environment.

CHESTERFIELD
112 Chesterfield Commons East Rd.
Chesterfield, MO 63005
314-697-4867

RICHMOND HEIGHTS
1505 S Big Bend Blvd,
Richmond Heights, MO 63117
314-384-1006