A relatively new approach, rTMS uses magnetism to stimulate and regulate your brain activity.
The first-line treatments for many mental health disorders include medication, psychotherapy, or a combination of the two. While these approaches are effective for many, millions still don’t experience many benefits.
Where can they go from here?
One treatment — whose concept was born more than a century ago but only recently fully launched — is repetitive transcranial magnetic stimulation (rTMS). This approach aims to change your brain activity via magnetism.
It’s most commonly used for people with treatment-resistant depression.
Transcranial magnetic stimulation (TMS) is a noninvasive treatment that uses magnetic pulses to stimulate and regulate nerve cells in areas of the brain related to various psychiatric disorders, particularly depression.
Repetitive TMS (rTMS) refers to the application of repetitive TMS pulses to a specific brain region.
Most often, rTMS is used in cases of treatment-resistant depression, which is when first-line treatments for depression aren’t resolving symptoms.
The first-line treatments for depression are antidepressant medications and psychotherapy. When these treatments fail to work, rTMS may be used as an alternative treatment or tried alongside medication or therapy.
In addition, rTMS may be used in other disorders, such as Parkinson’s disease, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).
It’s believed that rTMS promotes neuroplasticity, which is the brain’s ability to change and adapt in response to new experiences. In general, rTMS helps synchronize neurons, getting them to fire more actively over time. And when neurons fire together over time, they tend to fire in healthier ways.
For instance, rTMS has been shown to bring about changes in neuronal activity in brain regions linked to mood regulation, such as the
In particular, the dorsolateral prefrontal cortex is the region of the brain that is dysregulated in people with major depressive disorder. TMS targets the pathophysiology of depression with high-frequency electromagnetic pulses.
What happens in an rTMS session?
A physician must prescribe rTMS, which will involve a series of treatment sessions. A typical rTMS course involves 5 sessions per week for 4-6 weeks. Sessions vary in length but typically last between 30-40 minutes.
Sessions are administered by either the TMS physician or an experienced technician under the supervision of the physician.
Before you begin treatment, you’ll be asked to remove any jewelry, credit cards, and any other magnet-sensitive objects. You’ll be given earplugs to wear because rTMS makes a loud clicking sound with each pulse.
After you’ve been seated, the physician will properly position the coil over your head. The clinician will then measure your “motor threshold” with a few brief pulses. The motor threshold is the minimum level of power necessary to make your thumb twitch.
This varies from person to person and allows the clinician to know the amount of energy required to stimulate your brain cells.
When treatment begins, you’ll hear a series of clicking noises and feel a tapping sensation underneath the coil.
The process doesn’t require any anesthesia or sedation, so you can drive home after it’s finished and resume your regular activities.
The rTMS treatment is linked with only a few side effects, the most common being a mild headache, which is reported by about half of clients. These headaches are typically short-lived and can be treated with over-the-counter pain medication.
Some clients may experience painful scalp sensations or facial twitches with rTMS pulses. A few people may report temporary hearing problems immediately after the treatment due to the loud clicking sounds (reason for the ear plugs).
The most serious risk is seizures, but this risk is extremely low: 0.31 per 10,000 sessions and 0.71 per 1,000 clients.
While rTMS is generally considered safe, it’s important to note that it’s a relatively new treatment, and so there could be risks not yet identified.
People with depression who haven’t responded to medication are often candidates for rTMS treatment.
One 2013 study explored the long-term benefits of rTMS in 257 adults with major depressive disorder (MDD) that were non-responsive to antidepressants. Participants completed a course of acute TMS treatment and were assessed every 3 months for up to one year.
The findings showed that of those who achieved remission after initial treatment, 62.5% continued to remain symptom-free at the end of one year.
It’s important to note that about 36.2% of participants were given repeated sessions of rTMS as needed within the first month. Some were also taking antidepressant medication during the study.
- treatment-resistant depression
- post-traumatic stress disorder (PTSD)
- obsessive-compulsive disorder (OCD)
- tourette syndrome
- chronic pain syndrome
- generalized anxiety disorder (GAD)
- bipolar disorder
- movement disorders such as Parkinson disease, tremors, focal epilepsy, spasticity (abnormal increase in muscle tone or stiffness of muscle)
rTMS vs. other depression treatments
One benefit of rTMS over antidepressants is that it’s noninvasive and doesn’t come with the side effects often seen with antidepressant use: nausea, weight gain, fatigue, dry mouth, sexual dysfunction, or sedation.
Research also suggests that rTMS is more cost-effective for people who have gone through two courses of antidepressants without a positive response.
Compared to psychotherapy, rTMS is short-term, lasting only 4-6 weeks compared to at least 11-13 sessions of psychotherapy (what is generally recommended for lasting benefit).
However, if depression is primarily due to habitual negative thinking patterns, psychotherapy may better help get to the root of the problem and could have longer-lasting benefits.
Overall, combining treatments seems to work best. One study of 43 people with major depressive disorder found that adding psychotherapy, exercise, and sleep modifications to rTMS was far more effective than rTMS alone. A total of 89.2% of the participants saw symptoms reduction and 68% were symptom-free.
While still relatively new, rTMS appears to be a safe and effective treatment for people not benefiting from antidepressants or psychotherapy.
This noninvasive treatment uses magnetic pulses to stimulate and regulate neurons in brain regions associated with various psychiatric disorders.
It’s been successfully used in treatment-resistant depression with about half of clients experiencing fewer symptoms of depression. The procedure is also used to treat other disorders such as OCD, PTSD, and Parkinson’s disease.