What is Repetitive Transcranial Magnetic Stimulation? (rTMS)

I would like to preface this article by saying I am counsellor and not a medical professional or a doctor. The following account is my own perspective of how rtms works and is written in everyday language to help people deepen their understanding. Those interested in rtms should talk to their doctor or psychiatrist. Information on how to get a referral is listed at the bottom of the article. I hope this article stimulates curiosity about rTMS for those considering treatment for themselves or someone they know.

What is rTMS?

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation treatment for mood disorders. Magnetic pulses from the machine create an electrical field that communicates at the same frequency as the electrical signals of our brain. rTMS targets specific areas of the brain with either an inhibitory signal (telling this part of the brain to quiet down) or an excitatory signal (telling the brain to activate). Some forms of depression are characterized by low activity in the Left Dorsal Lateral Prefrontal Cortex (L-DLPFC). rTMS works to stimulate the L-DLPFC, strengthening neural circuits related to emotional regulation. Patients with anxiety have overactive DLPFC on the right side. For anxiety, inhibitory stimulation is used to quiet the R-DLPFC and return a healthy balance to the neural circuits of the brain. The repeated stimulations build stronger connections between the neural circuits creating long-lasting effects that extend beyond the session. The stimulation is localized and is not ECT. Patients remain conscious during treatment and even communicate with the technicians as the magnet pulses.

What does treatment look like?

Treatment often begins with a consultation with a psychiatrist. From there they will decide if you would be a possible candidate for rTMS, gather information about your symptoms, and answer any questions you might have. Which protocol is used is also decided during this consultation. Standard treatment for depression and anxiety takes about 5 minutes to perform and uses a theta-burst stimulation. Approved patients come to the clinic, every day, Monday to Friday for six weeks. Once completed patients have the option of coming in for maintenance treatments to maintain therapeutic gains.

Does it hurt?

This really depends as the experience of rTMS can vary between patients. Most patients report an uncomfortable but tolerable sensation at the treatment area itself. rTMS not only stimulates the brain but also the muscles on the scalp which feels like a tapping sensation on the head. The intensity of the treatment also depends on a patient’s motor threshold. This is a process that establishes the minimum amount of strength needed from the machine to therapeutically target the DLPFC. Patients with a high motor threshold can expect the tapping sensation to be more pronounced than someone with a low motor threshold. Patients may also report muscle twitching near the jaw and eyebrow. rTMS technicians are trained to make adjustments to the treatment to make sure patients are as comfortable as possible. Nervous about treatment? Don’t forget to breathe! Relaxing and exhaling during treatment can help reduce muscle pain. It also takes time for the body to de-sensitive to the treatment. Therefore the first week might be painful but patients quickly get used to the sensation.

What are the benefits and risks?

Similar to anti-depressants, mood stabilizers, and psychotherapy not everyone will respond to rTMS but those who do see a decrease in symptoms related to their anxiety and depression. Side effects to expect include headaches and dizziness following treatment. As well as some discomfort during the treatment itself. Any negative side effects are contingent to the treatment. Therefore, once treatment ends so will the headaches. The vast majority of rtms patients find the treatment tolerable and worth the reduction in depressive symptoms. rTMS is not recommended for people prone to seizures. rTMS carries the rare risk of triggering a seizure.

What else can rTMS Treat?

rTMS was originally designed and approved to treat depression. However, as research grows new protocols are emerging that treat the following: OCD, addiction, tinnitus, chronic pain, and PTSD.

How do I get involved?

To learn more about rTMS please contact us. We would be happy to answer any questions you have. If you would like to pursue rTMS I offer treatments through a third-party clinic and can guide patients through the process.