What is rTMS and how does it treat depression?

If you’ve been searching for alternatives to antidepressants, or your GP has mentioned TMS and you’re not quite sure what it involves, this guide is for you. We’ve written it to explain rTMS clearly, honestly, and without jargon — so you can decide whether it’s something worth exploring.

rTMS stands for repetitive Transcranial Magnetic Stimulation. It is a clinically approved, non-invasive treatment for depression, anxiety, OCD and several other mental health conditions. It works on the brain directly — without medication, without surgery, and without any significant disruption to your daily life.

Approved by NICE in 2015 and endorsed by the Royal College of Psychiatrists in 2017, rTMS is not a new or experimental treatment. It has been used worldwide for well over a decade and is backed by a substantial and growing body of clinical evidence.

How does rTMS work?

Depression is not simply a matter of mood or willpower. For many people, it has a neurological basis — specific regions of the brain that regulate mood, motivation, and emotional processing are underactive or poorly connected.

The area most commonly involved in depression is called the dorsolateral prefrontal cortex, or DLPFC. In people with depression, this region tends to show reduced activity. Standard antidepressants attempt to address this by altering the balance of chemicals in the brain such as serotonin, noradrenaline, dopamine. But for a significant number of patients, this chemical approach doesn’t produce adequate improvement.

rTMS takes a different approach entirely. A specialised electromagnetic coil is placed gently against the scalp over the target area. It delivers focused, repeated magnetic pulses — similar in strength to those used in an MRI scanner — which pass harmlessly through the skull and stimulate the nerve cells beneath.

This stimulation encourages the underactive brain cells to fire more regularly, improving the connectivity and functioning of the mood-regulating network. Over the course of a full treatment, the brain’s activity patterns begin to normalise — and symptoms of depression lift.

Unlike antidepressants, rTMS doesn’t work throughout the whole body. It targets the precise area of the brain responsible for the problem — which is why it helps many people for whom medication has not.

What happens during a session?

Each rTMS session is straightforward and takes place in our clinic in Cheadle. You sit comfortably in a reclining chair. A trained technician positions the magnetic coil against your scalp and the treatment begins.

You will feel a rhythmic tapping or clicking sensation on your scalp. This is the coil delivering its pulses. Most patients find it mildly uncomfortable at first but tolerate it well after the first few sessions. There is no pain, no sedation, and no anaesthetic.

A standard rTMS session lasts approximately 20 to 30 minutes. You can read, listen to music, or simply sit quietly during the treatment. When it ends, you can walk out, get in your car, and go about the rest of your day entirely as normal. There is no recovery period.

We also offer Theta Burst Stimulation (TBS) and Saint protocol, an FDA-approved accelerated protocol that delivers the same clinical benefit in just 3 to 4 minutes per session, completing a full treatment course in around one to two weeks rather than four to six.

How long is a course of rTMS?

A standard course involves one session per day, five days per week, over four to six weeks — minimum 20 sessions. The exact number of sessions is determined by your individual assessment and treatment plan.

Most patients begin to notice changes within the first two weeks — often a gradual lifting of mood, improved sleep, more energy, or a greater ability to engage with daily life. The full benefit of treatment continues to develop as the course progresses and in the weeks following completion.

Theta Burst Stimulation (TBS) and Saint protocol, are given more than 1 treatment a day, sessions lasing for 3 to 4 minutes per session, completing a full treatment course in around one to two weeks rather than four to six.

You do not need to stop your current medication to undergo rTMS. The two treatments are compatible and can work alongside each other without any known interaction.

Who is rTMS for?

rTMS is appropriate for a wide range of patients. It is particularly well-suited to:

• • People with depression who have not responded adequately to antidepressants (treatment-resistant depression)
• • People who have experienced unacceptable side effects from medication
• • People who prefer a non-medication approach to their mental health care
• • People with anxiety, OCD, PTSD, bipolar depression, postnatal depression, or seasonal affective disorder
• • People who are currently on medication but not achieving sufficient relief

rTMS is not suitable for people with certain metallic implants in or near the head, active seizure disorders, or certain implanted devices. A thorough screening and assessment is completed before any treatment begins.

What do the results look like?

The evidence for rTMS is clear and consistent. In our own published research at Tranquil TMS — conducted across our UK patient cohort and published in the Journal of Psychiatry Depression & Anxiety in 2020 — we recorded a response rate of 66.66% and a remission rate of 37.03%. Our most recent clinical audits show 66–76% of patients responding positively to a full course.

1 in 3 patients recover completely

1 in 2 achieve >50% reduction in symptoms

This compares to antidepressant response rates of 28–32% for treatment-resistant patients, as recorded by the landmark STAR-D trial — making rTMS a meaningfully more effective option for this population.

Patients who respond to rTMS typically describe a gradual but unmistakable improvement: more motivation, lower anxiety, better sleep, a returning sense of themselves. Many describe it as finally living rather than surviving.

Why Tranquil TMS?

We are the North West’s first and longest-running rTMS clinic, operating since February 2018. Our clinical team is led by two Senior Consultant Psychiatrists with over three decades of combined psychiatric experience.

We have treated huge number of patients, all conditions since opening, and our published research has been presented at the Annual Conference of the Royal College of Psychiatrists. Every patient receives a bespoke treatment plan, weekly clinical reviews by consultant psychiatrists, and a post-treatment report.

We are CQC-regulated and rated Good. Our clinic is based at Cheadle Royal Business Park, with free parking and easy access from Manchester, Liverpool, Cheshire, Sheffield and beyond.