From the Research
Transcranial Magnetic Stimulation (TMS) for depression is contraindicated in patients with metal implants, electronic devices, history of seizures, increased intracranial pressure, and significant head trauma, as well as in pregnant women and those with bipolar disorder who are at risk for manic switch. The most recent and highest quality study, 1, published in 2020, provides an update on the clinical use of repetitive transcranial magnetic stimulation in the treatment of depression, highlighting the importance of careful patient selection to minimize risks. Some key contraindications to consider include:
- Metal implants in or near the head, such as cochlear implants, aneurysm clips, or bullet fragments, due to the risk of the magnetic field interacting with these objects
- Implanted electronic devices like pacemakers, vagus nerve stimulators, or deep brain stimulators, as the magnetic pulses could interfere with these devices' functioning
- A history of seizures or epilepsy, as TMS may lower the seizure threshold
- Increased intracranial pressure or a history of significant head trauma, as TMS may exacerbate these conditions
- Pregnancy, which is considered a relative contraindication due to limited safety data
- Bipolar disorder, as patients may be at increased risk for manic switch with TMS, requiring careful monitoring It is essential to carefully evaluate each patient's medical history and current condition to determine the safest and most effective treatment approach, as supported by studies such as 2, 3, 4, and 5.