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What does rTMS do in Depression?

Brainclinic Stills

Science shows that the cause of depression is linked to the frontal cortex (the frontal lobe or dorsolateral prefrontal cortex (DLPFC)), where there is a disruption in communication between the DLPFC and the deeper anterior cingulate (AC). Repetitive Transcranial Magnetic Stimulation (rTMS) focuses specifically on this small area (DLPFC). The communication between these two structures can be improved with repeated stimulation of this area, thereby decreasing depressive symptoms for up to 6-12 months. A noticeable effect is usually achieved within 10 to 12 sessions of rTMS. Follow the link to find out more about how rTMS is applied in practice.

Due to the cyclical course of depression, patients may not need any more sessions after this treatment period. If complaints return, however, our therapists may recommend additional treatment sessions to achieve an ongoing anti-depressant effect.

Usually 78% of the people respond well to rTMS treatment and there are almost no adverse effects. The FDA in the U.S.A. considers rTMS as a safe therapy. One of the major benefits of treating depression with rTMS is that our patients have reduced or eliminated their dependency on antidepressant medication post treatment. This success rate has been achieved by therapists who have followed the neuroCare approach, combining neuromodulation techniques with psychotherapy.

By comparison, more than 40% of patients with depression do not respond to antidepressant medications such as Paxil (paroxetine), Effexor (Venlafaxine), Cipramil (Citalopram), Remeron (Mirtazapine) or Doxepin). Antidepressants are often prescribed for depression since the impact and results of antidepressants are known. 

We understand that rTMS is still relatively new treatment method, therefore we compare the advantages of rTMS with conventional antidepressant medications and provide you with more information on the criteria for undergoing treatment. For more information on the success of rTMS as a treatment method, follow the link below.

rTMS or antidepressants?

The two main types of medications currently prescribed for depression are: Tri-Cyclic Antidepressants (TCAs) such as Doxepin and Selective Serotonin Reuptake Inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) such as paroxetine, citalopram and venlafaxine. Sometimes ECT (electroconvulsive therapy) or electroshock therapy is used, but this has had limited application

Although treatment through the use of magnetic stimulation is relatively unknown extensive scientific studies under controlled conditions have been done into the effects of rTMS. Furthermore, rTMS therapy almost has no side effects, and can therefore be seen as a safe therapy, as concluded by the FDA (USA).

A trained therapist will be able to make an assessment of the individual needs of the patient to decide the best treatment options, but here we have compiled a list of benefits and advantages between anti-depressant medication and rTMS for the treatment of Depression.  For more information, a number of scientific publications related to depression, rTMS and personalized medicine are available.

Benefits of Antidepressants

  • Alleged efficacy extensively studied and shown
  • Easily available

Disadvantages of Antidepressants

  • Effectiveness of single medication is ± 40%
  • Risk of overdose (especially with TCAs)
  • Combination with other drugs and / or alcohol can be dangerous
  • Difficult to get rid of
  • Increased risk of suicide (particularly with adolescents)
  • Systemic treatment, allowing side effects to occur such as: nausea, fatigue, weight gain, insomnia, decreased libido, memory loss, sweating, increased heart rate, dry mouth and nightmares

Benefits of rTMS treatment

  • First effects are already felt within 10 sessions (2-3 weeks)
  • Prolonged effect after 4-8 weeks of intensive treatment
  • Local treatment leaving little to no side effects (possible side effect is headache and slight discomfort at the location where stimulated).

Disadvantages of rTMS treatment

  • In some cases, after 6-12 months a series of refresher sessions may be necessary to maintain effect.

Who can undergo rTMS?

rTMS is suitable for anyone with mild to severe symptoms of depression. The treatment is widely used in patients with treatment-resistant depression or patients who do not respond to antidepressants such as paroxetine, venlafaxine or citalopram. Research shows that patients with milder forms of depression very much benefit from treatment with rTMS.

Contra-indications:

If you have depression, you may qualify for rTMS treatment. There are only a few complaints known for which the probability of success is smaller, this includes people who suffer psychosis, schizophrenia or serious personality disorders.

A therapist would not recommend rTMS for those who have epilepsy or are pregnant. We would also contact your doctor if if you are prescribed an unregistered antidpressant or other drug (e.g. Parnate)