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 answer “what is rTMS?” clearly, honestly and without jargon, so you can decide whether it’s something worth exploring.

What is rTMS?

rTMS stands for repetitive transcranial magnetic stimulation. It is a non-invasive treatment used for depression, and also for anxiety, OCD and several other mental health conditions. It works on the brain directly, without medication, without surgery, and without significant disruption to your daily life.

rTMS for depression has been covered by NICE guidance (IPG542) since 2015 and was endorsed by the Royal College of Psychiatrists in 2017. It 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 involves specific regions of the brain that regulate mood, motivation and emotional processing becoming 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 often shows reduced activity. Antidepressants aim to help by altering the balance of chemicals in the brain such as serotonin, noradrenaline and dopamine. But for a significant number of patients, this chemical approach doesn’t produce adequate improvement.

rTMS takes a different approach. 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 through the skull and stimulate the nerve cells beneath.

This stimulation encourages the underactive brain cells to fire more regularly and is thought to improve the connectivity of the mood-regulating network. Over the course of treatment, many people find their symptoms of depression gradually ease.

Unlike antidepressants, rTMS doesn’t work throughout the whole body. It targets the area of the brain involved in mood, which is why it can help some people for whom medication has not.

What happens during an rTMS session?

Each rTMS session is straightforward and takes place at our clinic in Cheadle. You sit comfortably in a reclining chair. A trained practitioner 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. Some people find it mildly uncomfortable at first, but most get used to it within the first few sessions. It isn’t usually painful, and there is no sedation or anaesthetic. You can read more in our guide to what TMS feels like.

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, drive home, and go about the rest of your day as normal. There is no recovery period.

How long is a course of rTMS?

A standard course involves one session per day, five days per week, over four to six weeks, with a minimum of 20 sessions. The exact number of sessions is decided by your individual assessment and treatment plan. You can see each stage in our rTMS procedure guide.

We also offer accelerated protocols, including theta burst stimulation (TBS) and the SAINT protocol. TBS sessions last just 3 to 4 minutes, and in the large THREE-D trial it produced results comparable to standard rTMS for depression. Accelerated protocols can give more than one session a day, so a full course can be completed in around one to two weeks rather than four to six.

Many 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 benefit of treatment can continue to develop as the course progresses and in the weeks after it ends.

You usually do not need to stop your current medication to have rTMS; the two can normally be given alongside each other. Never stop or change medication without medical advice.

Who can have rTMS for depression?

rTMS can be suitable 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 getting enough 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 are the results of rTMS for depression?

rTMS has a substantial evidence base. In our own published research, 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 more recent clinical audits show 66–76% of patients responding to a full course.

66.66% response rate (published study, 2018–19)

37.03% remission rate (published study, 2018–19)

Response usually means symptoms have reduced by at least half; remission means symptoms have reduced to a minimal level. These figures come from routine clinical practice rather than a controlled trial, and results vary from person to person. rTMS does not work for everyone.

Patients who respond to rTMS typically describe a gradual but noticeable improvement: more motivation, lower anxiety, better sleep, a returning sense of themselves. Many describe it as finally living rather than surviving. You can read their words on our testimonials page.

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 many patients with a wide range of 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. You can find details of fees, payment options and insurance on our website.

If you are in crisis or having thoughts of harming yourself, please don’t wait for an appointment. Call 999, contact NHS 111 (choose the mental health option), or call Samaritans free on 116 123, day or night.

Frequently asked questions about rTMS

This article was written by the Tranquil TMS team. Tranquil TMS is a CQC-registered clinic in Cheadle, led by Senior Consultant Psychiatrists Dr Nikhila Deshpande and Dr Babu Nayar.