✓ Medically reviewed by Dr Kudrat Jain – Consultant Psychiatrist, SSHIMOH, Noida.
If antidepressants have not worked, or the side effects have been intolerable, rTMS is one of the options a psychiatrist may raise. It uses magnetic pulses to stimulate a specific region of the brain, requires no anaesthetic, and you drive yourself home afterwards.
It is not a miracle and it is not right for everyone. This page explains what it does, what a course involves, and how to think about it next to the alternatives.
What rTMS actually is
Repetitive transcranial magnetic stimulation uses a coil placed against the scalp to generate brief magnetic pulses. Those pulses induce small electrical currents in the cortex just beneath, most commonly over the left dorsolateral prefrontal cortex — a region consistently found to be underactive in depression.
Repeated over a course of sessions, this appears to shift activity in the wider network that regulates mood. Unlike ECT, no seizure is induced and no anaesthetic is used. You are fully awake, and you can return to normal activity immediately afterwards.
What a session is like
You sit in a chair. The coil is positioned against your head and the machine delivers pulses in trains, with short rests in between. Most people describe a tapping sensation on the scalp and a clicking sound — earplugs are provided.
A standard session lasts roughly twenty to forty minutes depending on the protocol; newer accelerated protocols are shorter. A typical course runs five days a week for four to six weeks, which is the main practical drawback: it requires you to attend regularly for over a month.
The first session includes mapping to find the right stimulation intensity for you, so it takes longer than the rest.
Who it helps
The clearest evidence is in major depression that has not responded adequately to at least one or two antidepressant trials. It is also used for obsessive-compulsive disorder with a different protocol and coil placement, and is being studied in a range of other conditions.
It is a reasonable option for people who cannot tolerate antidepressant side effects, people who prefer to avoid medication, and people for whom ECT feels unacceptable but something more than medication is needed.
It is generally not the right answer in an emergency. If someone is acutely suicidal, not eating, or psychotically depressed, a treatment that takes several weeks to work is not the priority — ECT is usually faster in those situations.
Who should not have it
The main absolute contraindication is metal in or near the head — aneurysm clips, cochlear implants, certain stents or electrodes. Dental fillings and most braces are fine.
A history of epilepsy or seizures requires careful assessment, because the main serious risk of rTMS is inducing a seizure. That risk is very low, but it is the reason a full medical history is taken first.
Side effects and risks
The most common side effect is scalp discomfort or a headache during or shortly after sessions, which usually eases as the course progresses and responds to simple painkillers. Some people find the clicking uncomfortable; earplugs address that.
Crucially, rTMS does not cause the memory effects associated with ECT, and there is no anaesthetic risk because no anaesthetic is used.
Seizure is the serious risk, and it is rare. Screening for epilepsy risk, medication that lowers seizure threshold, and alcohol or drug withdrawal is part of the assessment for exactly this reason.
How it compares
Against medication
Antidepressants are cheaper, do not require daily attendance, and are the sensible first step for most people. rTMS becomes relevant when medication has not worked or cannot be tolerated. The two are often used together rather than as alternatives.
Against ECT
ECT is more powerful and works faster, particularly in severe or life-threatening depression. rTMS is gentler, requires no anaesthetic, and has no memory side effects, but is less effective in the most severe cases.
For many people the practical question is not which is better in the abstract, but which is appropriate for how ill they are right now.
Against therapy
They do different things. Therapy changes patterns of thinking and behaviour; rTMS changes the biology that makes those patterns hard to shift. Combining them is common and sensible.
What to expect afterwards
Response, where it occurs, usually builds gradually over the course rather than appearing suddenly. As with any depression treatment, the question of maintaining the improvement matters as much as achieving it — that may mean continuing medication, ongoing therapy, or occasional maintenance sessions.
Relapse prevention is the part people skip. Our page on aftercare and relapse prevention sets out what a proper plan contains.
What the evidence actually shows
rTMS is an established treatment for depression that has not responded adequately to medication, and it is approved by regulators in several countries for that indication. Response rates in treatment-resistant depression are meaningful but not universal — a substantial proportion improve, a smaller proportion achieve full remission.
It is generally less powerful than ECT in severe depression, and it takes longer to work. Its advantages are tolerability and the absence of cognitive side effects, which for many people is the deciding factor.
Newer accelerated protocols deliver more sessions over fewer days and are an active area of research. If that is relevant to you, ask specifically what protocol is being proposed and what evidence supports it.
Practical considerations before you commit
The main practical barrier is attendance. Five sessions a week for four to six weeks is a significant commitment for anyone working or studying, and dropping out halfway through is unlikely to help.
Ask about the total number of sessions planned, the cost of a full course, whether any part is covered by your insurance, and what happens if you respond only partially. Our page on insurance and payment explains what to check in a policy.
Ask also what the plan is afterwards. rTMS without a maintenance strategy has the same relapse problem as any other depression treatment.
Who tends to do well
People whose depression has not responded to one or two adequate medication trials but who are not acutely unwell. People who cannot tolerate antidepressant side effects. People who are able to attend consistently for a month or more.
People who are acutely suicidal, not eating, or psychotically depressed are generally better served by faster-acting treatment. People with metal implants in the head, or significant seizure risk, may not be candidates at all.
A frank assessment will tell you which group you are in, and a good clinician will say so plainly if rTMS is not the right choice.
Assessment for rTMS: what we check
Not everyone who wants rTMS is a suitable candidate, and a responsible service will say so before taking payment for a course.
The assessment establishes the diagnosis first — rTMS for depression assumes the depression is unipolar and has been adequately treated with at least one or two medication trials. If there is an undiagnosed bipolar disorder underneath, that changes the plan entirely.
We screen for metal in or near the head, implanted devices, seizure history, medicines that lower seizure threshold, and current alcohol or sedative withdrawal, all of which affect safety.
We then discuss what is realistic: how many sessions, over how many weeks, the likely response rate for your particular situation, and what happens if the response is partial. Being clear about the attendance commitment in advance matters, because an abandoned course helps nobody.
Throughout the course, response is tracked with structured measures rather than impressions, and the plan for maintaining any improvement is agreed before the course finishes.
Frequently Asked Questions
Does rTMS hurt?
Most people describe a tapping or knocking sensation on the scalp rather than pain. Scalp discomfort and headache are the commonest side effects, and they usually lessen as the course goes on.
How long does a course of rTMS take?
A standard course is typically five sessions a week for four to six weeks. Each session lasts roughly twenty to forty minutes depending on the protocol used.
Will I need an anaesthetic?
No. You are awake throughout, and you can drive yourself home and return to normal activities immediately afterwards.
Does rTMS affect memory?
No. Unlike ECT, rTMS is not associated with memory impairment. This is one of the main reasons people choose it.
Is rTMS better than antidepressants?
Not better in general — different. Medication is usually tried first because it is simpler and cheaper. rTMS is considered when medication has failed or cannot be tolerated, and the two are often combined.
Can rTMS be used for anything other than depression?
Yes. It is used for OCD with a different protocol, and is under study for several other conditions. Your psychiatrist can advise whether the evidence supports it in your case.
References and further reading
- National Institute of Mental Health — Health topics
- World Health Organization — Depression
- NIMHANS, Bengaluru
Worth asking about if medication has not worked
If you have tried antidepressants without adequate benefit, rTMS is a reasonable thing to ask your psychiatrist about — along with what else might be adjusted first.
To discuss whether it is appropriate for you, call +91 72669 93399 or book a consultation at our Sector 117, Noida centre.