TMS Australia. A safety: a practical guide for psychiatrists
Rohan Taylor, Veronica Galvez and Colleen Loo
Date: 2018
TMS Australia a practical guide for psychiatrists (2018) Australasian Psychiatry
Overall, rTMS is a well-tolerated treatment with common side effects (such as headache or local pain at the site of stimulation) being mild. Severe adverse effects, such as seizures, hearing impairment or mania, are uncommon. Certain populations, including adolescents, pregnant women, older adults and those with metal/electronic implants, require special consideration when prescribing and monitoring treatment courses. With adequate assessment and monitoring processes, rTMS can be administered safely in a large proportion of depressed patients.
Before commencing a course of rTMS treatment, a comprehensive psychiatric and medical history must be obtained, and relevant physical examination performed (see Table 2). As demonstrated in this review, there are very few absolute contraindications to rTMS. Nevertheless, a structured safety screen (such as that developed by Keel et al.18) is a worthwhile addition to any TMS clinic procedure. The risk/benefit ratio should be carefully considered before recommending a treatment course in certain groups (pregnant women, adolescents, patients with implanted electronic devices and patients with pre-existing neurological conditions). In order to enhance the collection of data relating to safety (and efficacy) outcomes, we advise clinicians providing rTMS of the formation of the CARE network – this network aims to coordinate the collection of relevant clinical data for widespread quality improvement and allow for pooling of a large, naturalistic dataset for analysis.
