rTMS

  • Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that stimulates brain tissue to treat several mental health conditions.

    There is level A evidence for treatment of major depression, particularly in those who have not responded adequately to antidepressant medication.

    rTMS does not cause systemic side effects. It can be used when patients experience adverse side effects from antidepressant medications such as nausea, weight gain, and sexual dysfunction. rTMS is different from electroconvulsive therapy (ECT) - it is non-invasive and has fewer side effects. No anaesthetic is required, and no seizure is induced. Patients experience no memory loss or cognitive impairment after rTMS, and can return to daily activities immediately after treatment.

  • An rTMS course consist of up to 35 treatments performed daily or twice daily for a 2-to-6-week period. Each treatment session lasts 30 minutes.

    During the initial appointment, a consultant psychiatrist determines the correct magnetic field dose by stimulating the patient’s motor cortex and finding the minimum amount of energy required induce a twitch in their contralateral thumb. The patient’s rTMS prescription will be a percentage value of this Resting Motor Threshold.

    The treatment sessions are delivered by a trained clinician who remains with the patient during treatment. Patients are seated in a chair, are awake and alert, and can engage in other activities immediately after treatment.

  • An insulated electromagnetic coil rests on the patient’s scalp, which induces a strong, narrowly focused magnetic field. The field is rapidly switched on and off to create a small, targeted current that stimulates neurons directly under the coil.

    When treating depression, the coil is located over the Dorsolateral Prefrontal Cortex – a highly interconnected region of the frontal lobe which appears to be dysregulated in depression.

  • For those that respond to rTMS treatment, depressive symptoms may begin to improve as early as 10 treatments into the course. For some, improvement may be delayed until up to 4 weeks post treatment completion.

  • rTMS is generally well tolerated. However, as with all treatments, there are potential side effects.
    These include:

    • eyebrow or twitching while the treatment takes place

    • tapping sensation and/or pain at the stimulation site

    • headache/neck ache (25% of people)

    • fatigue (10-15% of people)

    Severe side effects such as seizure are rare. They occur in fewer than 1 in 50,000 people.

See through diagram of rTMS coil, magnetic field, and person

Eligibility and cost

  • TMS might be suitable for you if :

    • Are aged 18 years or older,

    • Have a depressive disorder diagnosis

    • Have trialled 2 different anti-depressant medications

    • Have tried psychotherapy

    Medicare may fund a course of up to 35 treatments provided you haven’t had a publicly or privately funded course of TMS previously.

  • Contact us for information about TMS eligibility for any of the conditions listed in the ‘What can rTMS treat?’ section of the website.

  • TMS is not generally recommended if you:

    • are under 18 years of age

    • have epilepsy

    • have an unstable neurological condition

    • have internal ferromagnetic metals

    • have implanted devices e.g. cochlear implant or cardiac pacemaker

  • The cost of rTMS treatment will depend on a number of factors:

    • Medicare

    If you are eligible under Medicare, The TMS treatments themselves are bulk billed - with no out of pocket cost.

    The initial appointment and Resting Motor Threshold test with Dr Boros-Lavack involves an out-of-pocket fee. We may bulk bill treatment if you are under financial hardship and will decide on a case-by-case basis.

    • DVA and WorkCover

    Both the Department of Veterans Affairs (DVA) and WorkCover fund rTMS treatment for eligible members with no out-of-pocket costs.

    • Private Health Insurance

    Some Private Health Insurers cover outpatient rTMS on a case-by-case basis. Contact your insurer to find out if you are covered.

    • Self-funded

    If you do not qualify for Medicare funding, you can self-fund your treatment. rTMS is available without Medicare funding for OCD, PTSD, addiction, tinnitus, and auditory hallucinations in schizophrenia. Treatment for these conditions is self-funded.

  • Your GP or psychiatrist can refer you for rTMS. Your doctor can access our referral form here.

    You’ll then have an initial appointment with Dr Boros-Lavack to ensure rTMS is the right treatment option for you.

How well does it work?

After a course of TMS treatments, approximately 40% of people with treatment resistant depression achieve full remission and 58% of people achieve a noticeable reduction in symptoms.

40%

60%

Percentage of people who are below the cutoff for depression after rTMS

58%

42%

Percentage of people who achieve a 50% or greater reduction in depressive symptoms after rTMS

Graph of rTMS treatment results

Standardised Mean Differences (SMD) of rTMS efficacy in meta-analyses of RCTs

Other conditions rTMS can treat

  • Many patients with generalized anxiety disorder (GAD) do not completely respond to first-line treatments. rTMS treatment shows a robust efficacy for patients with GAD.

  • Many studies have explored using rTMS to treat a variety of chronic pain conditions. Research shows improvements in neuropathic pain when applying stimulation to the primary motor cortex (M1), to the DLPFC, and using deep rTMS.

    Stimulation parameters, location, and number of treatments are dependent on patients’ pain condition.

  • Traditional treatments have failed to meet the needs of patients with tinnitus. Diminished neural input in the auditory pathways likely causes aberrant patterns of neural firing and the ‘phantom sounds’ associated with Tinnitus.

    rTMS can alter these firing patterns, targeting the temporoparietal junction with 1hz stimulation for 20 minutes per treatment, over 10 treatment sessions. Most patients who benefit from rTMS notice improvement for 1 - 6 months post treatment.

  • After a stroke, rTMS can suppress maladaptive plasticity, or enhance adaptive plasticity during rehabilitation. RTMS treatment is beneficial for both motor rehabilitation and for depression occurring post stroke. It is associated with improved upper limb muscle synergies, manual dexterity, walking, balance, and dysphagia.

    The primary motor cortex is usually targeted, the exact location, stimulation parameters and number of treatments vary with the patient’s stroke symptoms being treated.

  • rTMS has been TGA-approved for treatment of psychoactive substance use disorders (PSUD) of stimulant drugs for adult patients in Australia. Research also shows benefit treating behavioural addiction (e.g. eating, gambling).

    The left DLPFC is usually targeted with theta burst stimulation for 3 minutes, applied twice within 30 minutes, with a total of 20-36 treatments required in a course.

  • There is accumulating evidence supporting the use of rTMS in PTSD. It is a promising alternative and add-on treatment for PTSD patients who show limited response to antidepressant medication and/or trauma-focused psychotherapy.

    Several stimulation sites and treatment protocols show promise treating PTSD. Most commonly, we utilise 1hz stimulation to the bilateral supplementary motor area for 20 minutes. A PTSD treatment course usually involves 20-36 treatments, depending on patient response trajectory.

  • OCD is a debilitating and hard to treat condition. Estimates of between 40-60% of patients remain treatment refractory after first line treatments.

    rTMS treatment involves targeting the Supplementary Motor Area bilaterally with 1hz stimulation for 20 minutes. Patients ‘activate’ their OCD symptoms prior to treatment by thinking about their triggers until they feel between a 4/10 and 7/10 distress. This helps break the association between thoughts and compulsions.