Safety & Side Effects of TMS Part 7:Safety in Special Populations: Adolescents and Elderly
Transcranial Magnetic Stimulation (TMS) has been proven to be safe and effective in the general adult population, but what about younger patients or older adults? As interest in non-medication treatments grows, more families and physicians are asking whether TMS is appropriate—and safe—for people outside the traditional adult age range.
The short answer: yes, with some important considerations. Both adolescents and elderly adults can benefit from TMS, but treatment plans are often carefully customized to match each population’s unique medical and developmental needs.
TMS Safety in Adolescents
Depression, anxiety, and OCD are increasingly diagnosed in teenagers—and for many of them, medications either don’t work well or come with unwanted side effects. In these cases, parents and providers often look to TMS as a safer, drug-free option. Although TMS is not yet FDA-approved for patients under 18, research studies and real-world clinical experience have shown it to be safe and promising for teens, especially when standard treatments fail.
Several small clinical trials and observational studies have found that:
- Adolescents tolerate TMS very well, with side effect profiles similar to adults
- Most report only mild scalp discomfort or headaches that go away quickly
- There have been no long-term safety concerns reported when protocols are properly followed
Providers typically take extra precautions with younger patients, such as:
- Using lower starting intensities
- Gradually increasing the stimulation over several sessions
- Maintaining regular communication with both the teen and their guardians
The biggest factor in adolescent safety is patient maturity and ability to communicate. Teens must be able to sit still, follow instructions, and report how they’re feeling. For this reason, many clinics start considering TMS around ages 15–16, though some offer it younger depending on the case.
TMS Safety in the Elderly
At the other end of the age spectrum, older adults often benefit significantly from TMS, particularly if they’ve been resistant to medications or are sensitive to drug side effects. Antidepressants in the elderly can sometimes cause issues like sedation, falls, or drug interactions. TMS avoids all of these risks because it doesn’t enter the bloodstream or affect other organs.
Studies on TMS in adults over 60 have shown that:
- The treatment is well-tolerated, with side effects no different from younger populations
- Older adults often respond better than expected, especially with newer stimulation protocols like theta burst
- Cognitive function (memory, attention) is not negatively affected, and in some cases even shows mild improvement
That said, elderly patients may present with other health conditions—like hearing loss, limited mobility, or past brain injuries—that should be considered before starting treatment. Adjustments like extra head support, flexible scheduling, or slightly modified coil placement can help improve comfort and outcomes.
Individualized Care is Key
TMS may be built on science, but it’s delivered with clinical intuition and personalization. Nowhere is that more important than when working with special populations like teenagers and older adults. Age alone doesn’t tell the whole story—what truly matters is how well the treatment is tailored to each person’s unique brain, body, and circumstances.
For adolescents, individualized care means understanding more than just their diagnosis. Some teens may be dealing with trauma, school stress, social anxiety, or undiagnosed learning challenges. Their ability to communicate discomfort, stay engaged during sessions, or even sit still can vary dramatically. That’s why many providers begin treatment with a lower stimulation intensity and increase it slowly, based on how the teen responds—not just physically, but emotionally as well. Involving parents or guardians in check-ins can also help younger patients feel more supported and less anxious about the process.
In elderly patients, individualized care may mean reviewing a long list of medications and checking for conditions like mild cognitive impairment, arthritis, or hearing loss. These factors don’t disqualify someone from TMS—but they do guide how the treatment is delivered. A patient with a past stroke, for example, may need a slight adjustment in coil placement. Someone with neck stiffness might require extra support during sessions to stay comfortable. And for those with memory concerns, providers may implement additional cognitive monitoring to ensure the treatment is having a positive effect.
Whether the patient is 16 or 86, the provider’s role is to observe carefully, listen attentively, and adjust treatment in real time. That might mean shorter sessions, more frequent breaks, or even a slower ramp-up over the first few weeks. Providers trained in child and adolescent psychiatry or geriatric care are especially valuable in these cases, offering deeper insight into developmental and age-related nuances.
The bottom line is this: TMS is not a plug-and-play therapy. It’s a personalized process that works best when guided by thoughtful observation, compassionate listening, and the flexibility to adapt. That’s why safety in special populations depends not only on the science of the machine—but on the art of patient care.
Final Thoughts
TMS is not a one-size-fits-all treatment—but that’s part of what makes it so safe. With careful screening, tailored protocols, and close monitoring, both adolescents and elderly patients can safely benefit from the brain-changing effects of magnetic stimulation. As research grows, we’re likely to see broader approvals and even more customized approaches for these special populations.
Sources
- Croarkin, P. E., & MacMaster, F. P. (2019). Transcranial Magnetic Stimulation for Adolescent Depression. Child and Adolescent Psychiatric Clinics of North America, 28(1), 33–43. https://doi.org/10.1016/j.chc.2018.07.003
- Narang, P., et al. (2019). Is Transcranial Magnetic Stimulation Appropriate For Treating Adolescents with Depression? Innovations in Clinical Neuroscience, 16(9–10), 33–35. https://pubmed.ncbi.nlm.nih.gov/32082948/
- Sabesan, P., Lankappa, S., Khalifa, N., Krishnan, V., Gandhi, R., & Palaniyappan, L. (2015). Transcranial magnetic stimulation for geriatric depression: Promises and pitfalls. World journal of psychiatry, 5(2), 170–181. https://doi.org/10.5498/wjp.v5.i2.170
- Croarkin, P. E., & MacMaster, F. P. (2019). Transcranial Magnetic Stimulation for Adolescent Depression. Child and Adolescent Psychiatric Clinics of North America, 28(1), 33–43. https://doi.org/10.1016/j.chc.2018.07.003
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