Frequently Asked Questions

rTMS Treatment for Depression

Repetitive Transcranial Magnetic Stimulation (rTMS) treatment for depression was approved by NICE in 2015.

It is relatively new in the UK and many people are just finding out about this non-invasive, medication-free treatment for depression.

We’ve put together a page of answers to the most commonly asked questions.

Please feel free to browse our website for further information and send an enquiry if there’s something you’d like to know.

Questions & Answers

What is rTMS Depression Treatment?

Transcranial Magnetic Stimulation is an MRI-strength magnetic pulse designed to stimulate the brain.

In depression treatment, the left pre-frontal cortex is stimulated. This is the area of the brain that is responsible for positive feelings and it is integral to our emotional responses.

How long does a treatment cycle take?

The normal protocol is a 40 minute session per day, 5 times a week for 2-6 weeks: the overall duration of the treatment depends on how quickly the patient responds.

Our patients typically need between 20 to 30 sessions of rTMS to derive the most benefit.

Who can receive rTMS treatment?

rTMS therapy is an appropriate treatment for patients over the age of 18 with a depressive disorder.

If you or a loved one has been diagnosed with clinical depression or Major Depressive Disorder, then rTMS Therapy may be able to help.

Who should not consider rTMS treatment?

rTMS Therapy is a very well tolerated treatment and there are very few limitations as to who can receive it.

However, not all patients are appropriate candidates for rTMS Therapy. Patients with a history of seizures or who have metal implants in their brain not appropriate candidates for rTMS Therapy.

To determine if rTMS Therapy may be right for you, our consultant will screen for all the conditions which may make rTMS harmful.

What if I cannot receive rTMS treatment?

If rTMS is not the right form of treatment for you, your own doctor will continue to treat you according the NICE Guidelines for the management of depression, which may include referral to a specialised depression clinic.

Should I take my medicines while receiving rTMS?

Patients should continue to take antidepressant medication and any other psychotropic medication while receiving rTMS therapy.

How soon until the benefits start to show?

Patients typically need between 20 to 40 sessions of rTMS to derive the most benefit in the treatment of their depression symptoms.

In clinical trials, 1 in 2 patients achieved significant relief of symptoms after four weeks of treatment and 1 in 3 experience complete remission after six weeks of treatment.

Our clinical experience of the remission rate is considerably better than the published research.

Some patients may experience results in less time, while others may take longer.

Is it safe to use rTMS with concomitant medications?

rTMS Therapy is administered safely in the presence of antidepressant medication.

In randomised controlled trials varying levels of antidepressant medication have been used primarily to keep the patient’s state stable.

Changing medication treatment during a course of rTMS therapy is not recommended.

Likewise, some particular drugs such as Clozapine and heavy consumption of alcohol can lower the seizure threshold and should not be used in conjunction with the rTMS treatment.

Is rTMS Therapy a good alternative to antidepressants?

Most doctors and psychiatrists agree that rTMS Therapy is a good alternative for patients who cannot tolerate the side effects associated with antidepressant medications or do not wish to take them.

Some patients suffer intolerable side effects to commonly used antidepressants, such as nausea, diarrhoea, insomnia, sedation, lack of emotion, and sexual problems.

rTMS is non-systemic, so nothing enters your body or your bloodstream. That means that rTMS is free of the side effects typically associated with these medications.

This also means that patients can immediately return to regular activity after rTMS sessions, such as driving and work.

What is the difference between rTMS and antidepressants?

  • Antidepressants have numerous potential side effects such as nausea, diarrhoea, insomnia, sedation, lack of emotion, and sexual problems; rTMS has few side effects.
  • Antidepressants are systemic, meaning that the medicine enters the body and blood stream; rTMS is non-systemic.
  • rTMS is typically prescribed when antidepressants fail.

Is rTMS like ECT?

While both rTMS and Electroconvulsive Therapy (ECT) are effective in the treatment of depression, there are many differences in safety and tolerability.

Both are designed to treat depression through the application of energy into the brain, but the similarities end there.

ECT is a more intensive and invasive procedure than is rTMS as ECT requires an anaesthetic and is designed to stimulate a controlled convulsion. The main side effect from ECT is memory loss which does not occur with rTMS.

By contrast, rTMS is an outpatient procedure with few side-effects.

What about maintenance therapy?

Each patient’s course of treatment with rTMS is highly individual.

After the initial treatments, roughly half of patients experience relief and one third achieve remission of symptoms. Although our results are considerably better.

Relapses do occur and therefore the need for additional rTMS therapy may be required. Remission can usually be achieved again after a relapse with additional specialised sessions.

Is rTMS available on the NHS?

Basically, no. There are only a small number of NHS clinics (two nationally, at the time of writing, Dec ‘16) that offer rTMS for depression.

The NHS is not offering funding widely for TMS depression treatment currently.

Is rTMS covered by private medical insurance (PMI)?

Some health insurers do cover TMS for depression.  Our current understanding of the situation is shown on our website:

What is the cost of TMS treatment for depression?

Please see the pricing section of our website:

rTMS at The Smart Clinics in London

Repetitive Transcranial Magnetic Stimulation therapy treatment is available at Smart TMS, based at The Smart Clinics, Brompton Cross, London. Smart TMS was the first UK clinic to offer treatments for anything other than depression.

On the basis of research, we believe that rTMS – Repetitive Transcranial Magnetic Stimulation could offer sufferers of DPD an alternative treatment option using transcranial magnetic stimulation to work directly on the associated areas of the brain. It would also offer the benefit of being a non-medication approach, avoiding potentially unpleasant side-effects associated with drugs.

To discuss this further, please contact us.