TMS contraindications

rTMS is an innovative treatment method that can be effective for various conditions such as depression, obsessive-compulsive disorder (OCD), and anxiety disorders. While promising, rTMS is not suitable for everyone. Below you’ll find the main contraindications for rTMS treatment and learn whether rTMS could be a safe option for you.

 

What are contraindications for rTMS treatments?

If you recognize yourself in one or more of the contraindications listed, we advise against starting an rTMS treatment program. Always discuss this with your physician first, your GP can help you determine whether rTMS is appropriate in your situation.

Contraindications for rTMS treatment

  • Epilepsy or increased risk of seizures
  • Metal or electronic implants
  • Active brain tumors
  • Uncontrolled medication use
  • Pregnancy
  • Unstable medical conditions
  • Psychological contraindications
  • History of head trauma
  • Untreated trauma

 

Epilepsy or increased seizure risk

rTMS may lower the threshold for seizures, especially in individuals who already have an increased risk. For this reason, people with a history of epilepsy, or those suspected of having epilepsy, are generally advised not to undergo rTMS. At rTMS International, a (Q)EEG scan is required during the pre-treatment phase if epilepsy is suspected.

Examples include:

  • A direct family member (parent, sibling, or grandparent) has epilepsy.
  • You were adopted and lack information about epilepsy in your biological family.
  • There are possible signs of epilepsy, but this has not been investigated or ruled out.

Your GP can refer you to a hospital for further testing. Once the (Q)EEG report is submitted, your treatment application with rTMS International can continue.

 

Metal or electronic implants

The presence of metal or electronic implants in or near the head can be a contraindication for rTMS, such as:

  • Cochlear implants
  • Metal plates or screws
  • Aneurysm clips
  • Pacemakers
  • Implantable defibrillators
  • Deep brain stimulation (DBS) devices

These devices may interfere with the magnetic fields generated by rTMS, potentially leading to harmful effects.

 

Active brain tumors

Individuals with active brain tumors or other serious neurological conditions are usually excluded from rTMS. The effects of rTMS on tumors are not well studied, and safety in this context has not been established.

 

Uncontrolled medication use

Certain medications can influence the safety and effectiveness of rTMS, particularly those that lower the seizure threshold. In most cases, you can still undergo rTMS while taking medication, but it is important to discuss your current prescriptions with your physician before starting treatment.

 

Pregnancy

Although there is no clear evidence that rTMS is harmful during pregnancy, its use is generally not recommended due to the lack of research on potential effects on pregnant women and unborn children.

 

Unstable medical conditions

People with unstable or poorly controlled medical conditions—such as severe cardiovascular disease—should exercise caution with rTMS. The physical stress of treatment could worsen underlying health problems.

 

Psychological contraindications

rTMS is considered suitable for people with mild to severe depression, postpartum depression, seasonal affective disorder (SAD), and OCD. However, it is not recommended for individuals with:

  • Psychotic depression (hallucinations or delusions)
  • Severe bipolar disorder (especially during manic episodes)
  • Schizophrenia or other psychotic disorders (risk of worsening symptoms)

 

History of head trauma

A history of head trauma can increase the risk of complications with rTMS treatment. Brain injuries may cause structural changes such as scar tissue, which can alter the brain’s response to magnetic stimulation. This may reduce treatment effectiveness and increase side effects such as headaches or seizures. Additionally, metallic fragments or plates used in the treatment of head injuries can interfere with the magnetic pulses. Careful evaluation and monitoring are therefore essential for patients with past head trauma.

 

Untreated trauma

Applying rTMS in patients with post-traumatic stress disorder (PTSD) can be complex. Responses vary widely, some patients may benefit, while others may see little improvement or even a worsening of symptoms. PTSD is often associated with abnormal activity in areas such as the amygdala and prefrontal cortex. While rTMS can target these regions, its effectiveness is unpredictable. If you have unresolved traumatic experiences, it is recommended to first address these with trauma-focused therapy before starting an rTMS program.

 

Is rTMS right for me?

rTMS is a promising treatment option for several conditions, but it is not suitable for everyone. It is important to carefully consider whether rTMS is a safe and effective choice in your situation. If you’d like to learn more about contraindications or explore other treatment options for depression and anxiety, please contact us. Together, we can determine the best approach to support your health and well-being.

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