Repetitive Transcranial Magnetic Stimulation: How It Works, Benefits and Side Effects

Keegan Warrington
October 25, 2021

What are the most common repetitive transcranial magnetic stimulation side effects? If you’re considering this revolutionary treatment method, then you’ve probably asked this question. Perhaps, you’ve heard of rTMS before, and you’re skeptical about how the procedure works. But fret not. This article unpacks the basics of the procedure, its benefits to qualified patients, and commonly reported side effects. Read further and learn more about this revolutionary therapy in treating mental illnesses.

How Does rTMS Work?

Transcranial magnetic stimulation therapy or TMS is a non-invasive procedure used to stimulate nerve cells and nerve pathways. It is a common treatment for people with mental health issues where traditional clinical psychotherapy has proven ineffective. On the other hand, repetitive TMS or rTMS is a procedure performed in multiple sessions as prescribed by the psychiatrist.

The rTMS procedure consists of several sessions as prescribed by your psychiatrists. Moreover, rTMS isn’t automatically given to patients with mental illnesses. As a rule, rTMS is provided only if traditional clinical psychotherapy has been proven to be ineffective.

Psychiatrist’s Approval

You first need a recommendation from your psychiatrist to take transcranial magnetic stimulation therapy. However, if you’re reading this article now, don’t get your hopes up that your psychiatrist will make you qualified for this treatment. You should remember that rTMS isn’t a first-line treatment.

Psychotherapy and prescription medicines still reign superior over rTMS. And ultimately, the psychiatrist must—based on his professional judgment—declare that clinical therapy isn’t working. Moreover, you can also expect a physical exam and laboratory tests before qualifying for rTMS.

Before Procedure

Once you’re qualified, your psychiatrist will coordinate with a medical technologist on how the rTMS will be performed. They will identify specific parts of the brain that need to be stimulated. You can also expect the attending physician to discuss with you how the procedure will work and how long it will last.

During the rTMS Procedure

When the procedure starts, you’ll be asked to sit down on a reclining chair. You don’t need sedation during the whole session, which could take roughly around 30 to 60 minutes with resting intervals in between. Usually, stimulation lasts for two seconds with a resting interval of eight seconds. However, the stimulation and resting interval would depend on the prescribed rTMS procedure.

The technologist will then operate an apparatus that will be placed on your head. This apparatus is an electromagnetic coil where the electromagnetic waves come from. The apparatus will produce sounds during the procedure. Earplugs will be provided to reduce the uneasiness brought by the vibration. The electromagnetic coil will produce a knocking or tapping sensation. When you feel discomfort or a hint of pain, immediately ask the technologist to stop.

However, don’t be alarmed. rTMS doesn’t cause pain. Should there be any pain, be sure to inform the technologist immediately.

After the Procedure

You can immediately go home and drive after an rTMS session. It’s safe to go home right after the session. The repetitive transcranial magnetic stimulation side effects are generally minimal and rare. They include mild headaches,  slight feelings of dizziness, and a gentle tapping sensation, all of which typically go away on their own after a few hours.

Persons Qualified for rTMS

Generally, people who have suffered treatment-resistant depression are qualified for rTMS. Resistance to treatment pertains to the rejection of antidepressants and psychotherapy. Moreover, some patients experience medicinal side effects of taking antidepressants which leads to skipping the meds. Hence, the doctor may recommend rTMS if the patient cannot withstand the side effects.

Persons Automatically Disqualified for rTMS

Even if you suffer from treatment-resistant depression, certain overruling factors might automatically disqualify you. Here are the pre-existing conditions that automatically disqualify you for rTMS treatment:

  • Metal implants like aneurysm clips or coils, stents, deep brain stimulators, and electrodes
  • Metallic implants in the eyes or ears
  • Bullet fragments or shrapnel near the head
  • Tattoos on the face using metallic or magnetic-sensitive ink
  • Metal devices or objects implanted or near the head

How Effective is rTMS?

Is rTMS effective? That must be a question that boggles your mind. To be honest, medical experts still can’t fully comprehend the biological explanation behind rTMS. Meaning, there’s no objective evidence yet on how rTMS works. However, rTMS proves to be a great supplement to psychotherapy.

rTMS has proven to be effective with treatment-resistant major depressive disorders. However, rTMS has not proven effective in treating patients with obsessive-compulsive disorder, posttraumatic disorder, or schizophrenia.

Overall, the effectiveness of TMS comes from patients with feedback since there’s no biological evidence on how rTMS influences brain activity.

Repetitive Transcranial Magnetic Stimulation Side Effects

TMS is a painless treatment with minimal side effects. However, though it is painless, it is not sensation-free. A study by the National Center for Biotechnology Information (NCBI) mentioned that the most common side effect of rTMS is transient headaches. Other side effects include:

  • Scalp discomfort
  • Tingling sensation
  • Spasms or facial muscle twitching
  • Lightheadedness

In case you experience these symptoms, the doctor-in-charge can give you over-the-counter pain medication to relieve the symptoms.

Rare and uncommon side effects include:

  • Seizures
  • Mania
  • Temporary loss of hearing

There is not enough study to support claims for the repetitive transcranial magnetic stimulation side effects over the long term.

Who Can Benefit from rTMS?

Patients who have undergone psychotherapy without obvious improvement stand to benefit the most from rTMS treatment. Moreover, diagnosed patients who have taken at least one antidepressant but without success can also benefit from rTMS. The core principle behind rTMS is to stimulate the brain. People with depression tend to have low brain activity.

In conjunction with antidepressant drugs, rTMS can provide a booster for these drugs to work since the electromagnetic waves stimulate brain cells to reactivate. Aside from depression patients, people who aren’t qualified for electroconvulsive therapy due to a history of seizures or intolerance of anesthesia are eligible for rTMS treatment.


Several studies on repetitive transcranial magnetic stimulation defined this procedure as non-invasive and relatively safe to perform. Though there is no biological explanation on how it works, rTMS shows promising results in patients with major depressive disorder. However, patients need to remember that rTMS is not a first-line treatment for depression treatment, but an augmentation where the original treatment didn’t yield any helpful results.
Learn more about TMS treatment and how you can get the treatment at Roots TMS. Experience cutting-edge treatment to regain control of your life. Contact Roots TMS now at (562) 526-1748.

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Keegan Warrington