Depression Treatment: What is Repetitive Transcranial Magnetic Stimulation (rTMS)?

Repetitive transcranial magnetic stimulation is quite the mouthful. In fact, every time I say it to people I can guarantee quizzical looks in return. Nevertheless, I think repetitive transcranial magnetic stimulation (known as rTMS) is something people with depression, particularly treatment-resistant depression, should know about.

Magnets Used as Therapy

The idea that magnets can stimulate the brain has been around for a while and the first successful transcranial magnetic stimulation (TMS) study was conducted in 1985. Initially, TMS was used to stimulate motor cortex nerves to create muscle contractions. This method is much like applying direct current to the brain only it removes the discomfort to the patient.

Repetitive Transcranial Magnetic Stimulation Procedure

The procedure for rTMS is fairly simple and is done in a hospital or clinic on an outpatient basis. Patients are not anesthetised and the procedure is not painful (with the possible exception of a headache). Essentially, a patient is seated in a chair and the TMS device is placed near the scalp. The TMS device consists of a figure-eight coil of wire encased in plastic. This wire creates a pulsed magnetic field which penetrates the scalp and influences the electrical activity of the brain. Treatment location, strength and other variables are customized per patient. Treatments last about 45 minutes.

Most people are candidates for the therapy, but if you have a history of seizure, an implanted device or a few other things, you may not be. You do not have to stop your medication to receive rTMS.

In the initial treatment phase 20-30 sessions are given and, later, maintenance therapy is typically required. Maintenance therapy is generally required after several months up to three years later, depending on the individual. Maintenance treatment consists of half the number of treatments as the initial treatment phase.

Risks of Repetitive Transcranial Magnetic Simulation

Risks for rTMS are actually relatively minor as it’s a targeted, external stimulation. Some of the noted risks are:

• headache in about 1-in-10 patient—typically relieved by over-the-counter pain medication
• sleep disruption
• an increase or decrease in energy post-procedure
• seizure (this risk has always been noted but hasn’t been seen in treatment since 1998)

Does Transcranial Magnetic Stimulation Therapy Work?

That is a question for the professionals, naturally, but yes, the scientific evidence says it works. Meta-analysis reveals that rTMS is slightly more effective than pharmacological treatment but significantly less effective that electroconvulsive therapy (ECT). The advantage rTMS has over ECT is the massive reduction in side effects.

Cost of Repetitive Transcranial Magnetic Stimulation

The reason more people don’t get rTMS is the cost. The only numbers I have on cost are from Canada and you can expect a drastic increase in cost in the United States. In Canada, an initial treatment of 20-30 sessions costs between $5,000 and $7,500. Often these costs are not covered by insurance although we are seeing some changes in this as the treatment becomes more accepted. A cost-benefit analysis, though, shows that ECT is probably more cost-effective than rTMS and ECT costs generally are picked up by insurance companies.

The Bottom Line on Repetitive Transcranial Magnetic Stimulation

In my opinion, this is a safe and fairly effective treatment in many cases of treatment-resistant depression—which is, overall, great news. This treatment hasn’t shown the positive effects doctors would have liked (i.e. it is not as effective as ECT) but that doesn’t mean it doesn’t work for some. Unfortunately, the cost and the fact that people need additional maintenance treatments makes this treatment out of reach for most. Nevertheless, knowledge and acceptance of this treatment has the possibility of helping many.