Transcranial magnetic stimulation

Our rating
Children and adolescents Question mark: This treatment has not been properly researched. It is not possible to say whether it is useful or not.
Adults 3 smilies:  This treatment is very useful. It is strongly supported as effective by scientific evidence.
Older adults 1 smiley:  This treatment is promising and may be useful. It has some evidence to support it, but more evidence is needed to be sure it works.

What is it?

In transcranial magnetic stimulation ('TMS'), a magnetic coil is placed next to the scalp. The coil delivers magnetic pulses which cause electrical changes in the brain and stimulate brain cells. The magnetic pulses are delivered repeatedly, so the treatment is known as known as repetitive TMS (rTMS).

rTMS for depression usually involves multiple sessions, delivered daily over a few weeks. Each session usually lasts around 30 minutes.

In the most commonly used form of rTMS, the coil is placed over the left front area of the brain. This type of rTMS uses fast pulses. It is called High Frequency rTMS. Low Frequency rTMS uses slower pulses. In this form, the coil is placed over the right front area of the brain or over both sides of the brain.

How does it work?

rTMS changes brain activity. It is not known exactly how this affects depression.

High frequency rTMS increases activity in parts of the brain that may be under-active in people with depression. Low frequency rTMS decreases activity in parts of the brain that may be overactive.

rTMS can also change blood flow in the brain and the concentration of different brain chemicals.

Is it effective?

Some studies have compared rTMS with sham rTMS to see if rTMS is effective. In the sham form of rTMS, either a fake coil is placed over the scalp, or a real coil is used but is pointed away from the scalp.

High Frequency rTMS

This form of rTMS has been studied the most often. These studies have found that rTMS is more effective than sham rTMS at reducing depression symptoms. It can also be effective for some people who have depression that has not been helped by medication or psychological therapies.

Other studies have compared high frequency rTMS to ECT (Electroconvulsive Therapy). In these studies, ECT was more effective at reducing depression symptoms, but rTMS generally has fewer side effects.

Low Frequency rTMS

Some studies have compared low frequency rTMS with sham rTMS. These studies have suggested that low frequency rTMS may also be effective.

More research is needed on rTMS. Studies so far have often involved small groups of people. Doctors are still working out the best ways to use rTMS. This means the treatments used in different studies have not been exactly the same. For example, the number of treatments is not always the same over different studies.

It is not yet clear whether successful rTMS treatments produce improvements that last over time.

TMS has mainly been studied in adults. There is a small amount of evidence to suggest that it is also effective in older adults. However, research on older people has found smaller effects. There is little evidence about TMS use in children and adolescents.

Are there any disadvantages?

Some common side effects of rTMS include headaches, discomfort on the scalp, tingling and light-headedness. More serious side effects are rare. Serious side effects include seizures, hearing loss, and mania. Doctors use rTMS under special guidelines designed to reduce the risk of seizures and other problems. 

More research is needed to understand if there are any long-term side effects of rTMS. 

Where do you get it?

rTMS is still an experimental treatment. It is available in many parts of Australia although it can be hard to get. It is available through some state public health systems. It is available in research trials and some clinics and hospitals offer rTMS as a private health service.

rTMS can be expensive and is not currently covered by Medicare. If you are interested in rTMS it is recommended you speak to a GP who can provide more information. 

Recommendation

Psychological therapies and anti-depressant medication are still the first options for treatment. If these are not helpful for your depression, you might consider rTMS. Your doctor will help you work out if rTMS might be suitable for you. If you are treated with rTMS, specialist doctors will work out which type is best for your condition.

rTMS can be effective for adults and older adults. However, more research is needed before a recommendation can be made for children and adolescents.

Key references

  • Berlim MT, van den Eynde F, Tovar-Perdomo S, Daskalakis ZJ. Response, remission and drop-out rates 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. 2013;1-15.
  • Berlim MT, Van den Eynde F, Daskalakis ZJ. A systematic review and meta-analysis on the efficacy and acceptability of bilateral repetitive transcranial magnetic stimulation (rTMS) for treating major depression. Psychological Medicine. 2012;1-10.
  • Berlim MT, Van den Eynde F, Jeff Daskalakis Z. Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials. Neuropsychopharmacology. 2013;38(4):543-51.
  • Berlim MT, Van den Eynde F, Daskalakis ZJ. Efficacy and acceptability of high frequency repetitive transcranial magnetic stimulation (rTMS) versus electroconvulsive therapy (ECT) for major depression: a systematic review and meta-analysis of randomized trials. Depress Anxiety. 2013;30(7):614-23.
  • Loo, C.K., McFarquhar, T.F., Mitchell, P.B. A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression. International Journal of Neuropsychopharmacology. 2008;11:131-147.

Last reviewed and updated: 1 May 2019