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.

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.

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.

rTMS is a proven, non-invasive treatment for various conditions, especially effective for depression, outperforming antidepressants for those with treatment-resistant depression. Research, including a 2017 study of 81 trials with 4233 patients, shows rTMS is more effective than sham stimulation. The Sackeim 2020 study, involving 5010 patients, reported response and remission rates of 58% and 28% (intention-to-treat) and 83% and 62% (for those completing at least 20 sessions).

Most trials focus on patients with significant treatment-resistant depression, showing a response rate of over 45% in those who failed more than 5.5 medication trials.

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 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.

We have protocols for several mental health conditions including depression, anxiety, PTSD, OCD, ADHD, chronic pain and tinnitus.

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.

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).

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.