Repetitive transcranial magnetic stimulation (rTMS)
What is rTMS?
With over 25 years of research, rTMS, or Repetitive Transcranial Magnetic Stimulation is a novel and effective treatment for depression. TMS has been used to treat tens of thousands of people with depression worldwide. It has also been used to treat conditions such as anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder.
Where is the evidence for rTMS?
Although in Australia, it only relatively recently became a routine part of clinical practice, there has been substantial research evaluating the antidepressant efficacy of the use of transcranial magnetic stimulation in the treatment of depression. This has been established through a "relatively traditional pathway" beginning with small case series, to single-site clinical trials then to larger multisite randomised double-blind controlled trials. Antidepressant effects have been confirmed in meta-analyses and umbrella reviews. As of 2022, rTMS has been shown to have produced meaningful response and remission rates outside of clinical studies for over 5000 patients.
How does rTMS work?
rTMS uses a pulsing electromagnetic coil positioned on the patient’s head to generate a magnetic field to stimulate the nerve cells of the brain.
While there could be multiple reasons why people may have depression, a possible reason for depression may be due to under-active regions of the brain controlling emotions. Stimulating the prefrontal cortex with TMS activates the positive mood circuits in the limbic system which is the emotional centre of the brain.
TMS targets your prefrontal cortex and stimulates the limbic system, the emotional centre of the brain.
Transcranial: Passing through the skull
Direct Current Stimulation: Directing an electrical current to stimulate specific parts of the brain
Neuromodulation: Altering nerve activity in the brain by delivering treatment to a specific area.
How effective is rTMS?
rTMS is an effective, non-invasive, treatment proven to treat various conditions. rTMS is particularly effective for depression as TMS has been found to be more effective than antidepressants or other alternatives for those with treatment-resistant depression.
In 1995, pilot clinical trials suggested that rTMS produced antidepressant benefits as a vast majority showed a benefit of rTMS therapy over sham stimulation. In 2017, in a study including 81 rTMS trials, with a total of 4233 patients, different forms of rTMS were all found to be more effective than sham stimulation for both response and remission rates.
Sackeim 2020 study describes the outcomes of 5010 patients treated at 103 practices at both intention-to-treat basis (ITI) and for treatment completers who had received at least 20 rTMS sessions. Response and remissions rates were 58% and 28% in the ITI group and 83% and 62% in patients completed at least 20 treatments. It is necessary to note that the vast majority of trials demonstrating the effectiveness of rTMS have been conducted with patients with significant levels of treatment-resistant depression. On average, of over 1100 patients, we found a response rate of over 45% in a group of patients who averaged more than 5.5 failed medication trials.
Are there side effects of rTMS?
In comparison to antidepressants and Electroconvulsive Therapy, rTMS has minimal side effects. In rTMS studies, there was no difference in the dropout rates between active and sham groups suggesting a high degree of acceptability and tolerability of treatment.
Side effects may include scalp discomfort for 5% of patients undergoing treatment and tiredness or headaches for 20% of patients but these effects are often transient and disappear after a couple of sessions. There are no metabolic consequences of antipsychotics or the risk of renal or thyroid impairment as there would be with lithium therapy. Less than 2 out of 100000 treatment sessions may be at risk of seizure induction.
The discontinuation rates of patients having rTMS in clinical trials are numerically lower than those seen in sham-treated patients and dramatically lower than typical antidepressant medication discontinuation.
What does rTMS treat?
When should I consider rTMS?
TMS is a great option for those who have a preference for a non-drug treatment due to poor medication response or have problems with medication interactions or systemic medication side effects.
Public funding like Medicare stipulates that patients must have trialled 2 or more classes of antidepressants before qualifying to be MBS subsidised. Therefore those who tried and failed 2 or more antidepressants or those considering ECT for their severe depression should consider rTMS as a viable option.
Frequently Asked Questions About TMS
rTMS is not the same as electroconvulsive therapy (ECT). TMS uses magnetic pulses on specific areas of the brain and does not require an anaesthetic. You can go about your normal activities, including driving, immediately after treatment.
Electriconvulsive therapy (ECT) uses electric current to induce a seizure in a sedated patient's brain. While ECT may be a more effective treatment for depression, ECT does come with several possible risks and side effects such as loss of memory, heart rhythm disturbances, low blood pressure, headaches and nausea.
Sessions typically take 30 minutes, meaning you can schedule sessions to fit in with your day.
The typical treatment schedule for a patient is 3 - 5 sessions per week for 35 sessions (7-12 weeks).
People generally respond to TMS treatment within 4 weeks. Those treating with Monarch will receive review sessions with the psychiatrist to discuss the effectiveness of the treatment.
Our co-founder Professor Paul Fitzgerald has spent decades studying TMS and its applications. We are proud that all our protocols at Monarch Mental Health Group are underpinned by the research done by our Monarch Research Institute.
The information on this page and research of effectiveness of rTMS for depression is outlined in Professor Paul Fitzgerald's research article.
Treatment For Antidepressant Resistance
Transcranial Magnetic Stimulation (TMS) offers a solution for those who find themselves resistant to traditional antidepressant treatments or experiencing challenges when transitioning between different antidepressants. This innovative neurostimulation technique provided by Monarch Mental Health Group is particularly beneficial for patients seeking an alternative path to mental wellness. Because TMS is an outpatient procedure, patients can resume normal daily tasks right away following a session.
Speak To Us For TMS Treatment
At MMHG, we recognise the difficulties associated with mental health issues and the frustration that treatment-resistant depression can cause. Our dedicated staff is committed to offering personalised care, making sure that every patient's road to recovery is supported and successful. TMS is a route to regaining control over one's mental health and finding joy again, not just a treatment.
The new medication is designed to act like training wheels for your antidepressant therapy - providing fast relief of your symptoms while giving your antidepressants time time to work.