This page has been written by the Neuropsychiatry Department at the National Hospital for Neurology and Neurosurgery. The aim of this page is to provide general information about the procedure called Repetitive Transcranial Magnetic Stimulation (rTMS). Your neuropsychiatrist will discuss the procedure with you in detail. It is intended for use by patients (or their families or carers) referred to our service and who may be offered this procedure. It is not intended to replace discussion with your consultant. If you have any questions, please do not hesitate to ask a member of the team caring for you.
This treatment uses magnetic pulses to stimulate certain brain areas. It is delivered using an insulated magnetic coil that is placed over the scalp.
rTMS is applied over an area at the front of the brain, usually on the left side. This area is considered to be involved in emotion or mood regulation. Stimulation of this area increases the activity and connections between the brain cells which can improve the symptoms of depression.
Studies have shown that many people can experience improvement in depressive symptoms when treated with rTMS and some recover completely. However, there is no guarantee that this treatment works for everyone.
rTMS has been recommended by the National Institute for Health and Clinical Excellence (NICE) as a treatment for depression.
You can be considered for this treatment if you suffer from moderate to severe depression and if:
- You have not responded to standard treatments such as antidepressant medications or psychological therapy.
- You are unable to tolerate the side effects of the antidepressant medications.
This procedure to treat depression is new for UCLH.
All treatments and procedures have risks and your consultant will discuss the risks of rTMS in detail with you.
Problems that may happen straight away
- Mild discomfort at the treating site on the scalp.
- Mild twitches in the muscles of your face during the procedure only.
- You may feel faint or dizzy during the treatment but this is rare. If this happens, we will stop the treatment and get you to lie flat until you feel better. Treatment can usually continue the following day.
Problems that may happen later
- Headaches can sometimes occur after the treatment, and standard pain medication, such as paracetamol, can help.
Problems that are rare, but serious
- There is a small risk of a seizure during the treatment but not afterwards (less than 1 in 1000).
There are no reported long term adverse effects from having rTMS treatment.
You cannot have rTMS if you have any metal objects in your head or neck areas including: metal plates in head, aneurysm clips or coils, electrodes, stents in neck or brain, shrapnel or metal fragments, cochlear implants, pacemakers, vagal nerve stimulators and deep brain stimulators. Head or facial tattoos if they have ferromagnetic containing ink
Your depression will continue to be managed with the standard treatments of antidepressant medications and/or talking therapy. Your depression may last a long time if medications or talking therapies are not helpful. This can affect your everyday life and relationships.
Your psychiatrist will discuss with you the alternative treatments for your depression and their risks and benefits. These include:
- Antidepressant medications. Switching to another medication may be helpful. More than one medication may be recommended. However, there may be side effects from medications.
- Talking therapies. For example, cognitive behaviour therapy or counselling can be helpful. However, it may not be effective for everyone.
The procedure is non-invasive and no anaesthetic is used. You are fully awake during the treatment. You can eat, drink and take your usual medications before your treatment.
Each treatment session usually lasts up to 30 or 40 minutes. The standard course of treatment is one to two daily sessions, five times a week (Monday to Friday) for up to six weeks. Depressive symptoms can improve as early as two to three weeks.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please don’t hesitate to speak with a senior member of staff again.
The rTMS treatment will be conducted during your admission to the neuropsychiatry inpatient ward. The rTMS equipment is located in a different department of the hospital so you will be taken there by a member of staff from the ward. Treatment is given by a trained clinician who will monitor you throughout.
You will be asked to remove any metal jewellery including earrings, necklaces, hairclips, mobile phone and bankcards as these can be affected by the magnetic field.
You will be seated in a comfortable chair. During the first session, several measurements are made to ensure that the magnetic coil is correctly placed. The amount of magnetic energy you require for the treatment will be determined and this varies from person to person.
You will be given ear plugs to wear during the treatment as the stimulator can be noisy. The magnetic pulses produce a clicking sound and you will feel a tapping sensation on your scalp where the coil is placed.
After the treatment, you will be brought back to the ward. The nursing team will review you. You can move about, eat or drink and do normal activities. If you feel you need to rest or have a headache, let the nurses know. Standard pain medication, such as paracetamol can be prescribed.
You will have regular reviews with your consultant psychiatrist and the team on the inpatient ward.
www.rcpsych.ac.uk www.nice.org.uk
UCLH cannot accept responsibility for information provided by other organisations.
Berlim MT et al. (2014) Response, remission and drop-out rate following high- frequency repetitive transcranial magnetic stimulation (rTMS) for treating major depression: a systematic review and meta-analysis of randomized, double-blind and sham-controlled trials. Psychological Medicine. 44(2), 225-39.
Gaynes BN et al. (2014) Repetitive transcranial magnetic stimulation for treatment- resistant depression: a systematic review and meta-analysis. Journal of Clinical Psychiatry. 75(5), 477-489.
Kedzior KK et al. (2015) Durability of the antidepressant effect of the high-frequency repetitive transcranial magnetic stimulation (rTMS) In the absence of maintenance treatment in major depression: a systematic review and meta-analysis of 16 double- blind, randomized, sham-controlled trials. Depression and Anxiety. 32(3),193-203.
McClintock SM et al. (2018) Consensus Recommendations for the Clinical Application of repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. National Network of Depression Centers rTMS Task Group; American Psychiatric Association Council on Research Task Force on Novel Biomarkers and Treatments. Journal of Clinical Psychiatry. 79(1), 16cs10905.
Rossi S et al. (2021) Safety and recommendations for TMS use in healthy subjects and patient populations, with updates on training, ethical and regulatory issues: Expert Guidelines. Journal of Clinical Neurophysiology. 132(1), 269-306.
Hughlings Jackson ward (Neuropsychiatry inpatient unit) The National Hospital for Neurology and Neurosurgery Queen Square
London
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