Repetitive transcranial magnetic stimulation (rTMS) is a first-line treatment for treatment resistant depression (TRD) based on the Canadian Network for Mood and Anxiety (CANMAT) Guidelines. Approximately 30% of patients with depression are considered to have TRD. Numerous double-blind placebo controlled trials have demonstrated significantly increased response rates with rTMS treatment for TRD.

rTMS is FDA-approved for the treatment of major depressive disorder (MDD) and as an adjunct treatment for obsessive-compulsive disorder (OCD). For MDD, it is indicated after at least one failed antidepressant trial in the current depressive episode. rTMS is used as an adjunct treatment in combination with exposure-response prevention (ERP) therapy and pharmacotherapy for the treatment of OCD. rTMS is also effective in treating anxiety disorders (generalized anxiety disorder, post-traumatic stress disorder) but this is currently considered off-label treatment. rTMS has also been shown to be effective in treating symptoms of depression secondary to traumatic brain injury or concussion.

rTMS uses magnetic pulses to stimulate neuronal pathways in the brain that are altered in mental illness. Although the exact mechanisms of its therapeutic effects is not fully understood, repeated activation of neuronal networks can alter their activity and re-establish balance between circuits. It is also believed to increased the production of brain derived neurotropic factor (BDNF) which helps in the process of neurogenesis and neuroplasticity.

Unlike electroconvulsive therapy (ECT), another neuromodulation treatment for TRD, no anaesthesia is required and the patient is fully conscious during rTMS treatment.

A typical rTMS treatment course is 5 days/week for 6 weeks, for a total of 30 treatments, which may be followed by a tapering and/or maintenance schedule. Treatment time ranges from 3.5 minutes to 30 minutes depending on the protocol used. In certain cases, we also administer an accelerated protocol where a patient receives 50 treatments of intermittent theta-burst stimulation (iTBS) over a 1-2 week period. Throughout treatment, we track response with symptom severity scales.