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Repetitive Transcranial Magnetic Stimulation (rTMS) for Depression

Repetitive Transcranial Magnetic Stimulation (rTMS) is a proven treatment for depression and possibly other psychiatric disorders. Studies have clearly shown that rTMS is an effective treatment for patients with depression. For further information and research regarding Transcranial Magnetic Stimulation, please access the Black Dog Institute TMS Fact Sheet at http://www.blackdoginstitute.org.au/docs/TMS.pdf

What is rTMS?

rTMS is a non-invasive procedure that involves the focused application of magnetic energy to superficial regions of the brain, thus inducing small electrical currents. During an rTMS procedure, an electrical current passes through a small coil placed close to the scalp. This current induces a magnetic field. The magnetic field can pass into the brain without resistance. If the magnetic field is of sufficient strength, it will stimulate electrical activity in nerves below the coil, that is, in superficial regions of the brain. 

rTMS in Depression

Studies have evaluated the role of rTMS in the treatment of depression since the mid-1990s. These studies have clearly shown that rTMS is more effective than a placebo type of stimulation, especially in patients who have not responded well to antidepressant medication treatment. 

How is rTMS Administered?

rTMS is administered as a course of 20 treatments which are generally administered on a daily basis. Sessions usually take between 20 and 45 minutes per day depending on the protocol being utilised. During an rTMS session a patient is awake, alert and aware of what is happening at all times and is seated in a comfortable chair. Before the treatment course begins, the treating Psychiatrist will undertake threshold testing to ensure that the correct prescription is tailored for the patient for the treatment sessions. 

The patient may feel small twitches in the hand during this procedure. It is not painful. This procedure is done to establish how high the machine intensity needs to be sent to affect the brain in an individual patient.

During the treatment itself, a coil is usually placed on the scalp (held by hand or with a coil stand) near the front region of the brain. This may be on the left or right depending on how the treatment is being given. The coil is connected to a machine that generates the electrical current.  As the magnetic field is produced by the electrical current being switched on and off, the machine produces a clicking sound although the patient will usually wear disposable ear plugs to prevent any discomfort of the sound. The patient may feel a tapping sensation under the coil (this occurs due to a twitch produced in scalp muscles as the magnetic field crosses into the brain). The magnetic field can also stimulate small nerves around the head and face, producing a muscle twitch in the forehead, face or eye region.

Antidepressant medications may be prescribed, especially to try and prevent relapse after the treatment with rTMS finishes.

Risks and Side Effects

As is the case with any treatment, there is the potential for mild side effects. For more information and to discuss potential side effects, please contact our Admissions and Assessment team to arrange an appointment with a Consultant Psychiatrist effects can be discussed. Futher information can be obtained by visiting the Black Dog Institute website at www.blackdoginstitute.org.au 

Exclusion Criteria

The following exclusion criteria apply:

  • Epilepsy
  • Any past seizure
  • Neurologic Illness
  • Neurological surgery
  • Head injury
  • Concussion
  • Fainting or Syncope

The safety of rTMS in pregnancy has not been evaluated and is not recommended at this time.

Treatment Program

Currumbin Clinic has an accredited team of Clinicians who administer rTMS as part of an inpatient admission program.  Average length of stay is 21 days.  During this time patients will also be enrolled in a depression specific psychoeducation program designed specifically to provide them with skills and strategies to support their recovery.

Referral Process

Please contact your Doctor or the Currumbin Clinic Admissions and Assessment team on 07 5534 4944 to discuss options for rTMS treatment. A General Practitioner referral is required for all admissions and appointments.