Transcranial Magnetic Stimulation

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive medical procedure, approved by the College of Psychiatrists, for the treatment of a number of psychiatric conditions. rTMS is a brain stimulation technique that relies on the generation of brief magnetic fields using a coil that is placed over your scalp. These magnetic pulses induce an electrical current that briefly activates neurons at the site of stimulation. rTMS has been shown to be a safe and well-tolerated procedure that can be an effective treatment for adults with depression and other psychiatric conditions.   The duration of effects of rTMS treatment can vary from patient to patient. Some patients may have a lasting clinical improvement, others may experience short-term improvement and some patients may not experience any benefit. Patients who have short term improvement may benefit from repeat courses of treatment and / or maintenance treatment.  

There may be alternative treatment options for your condition, including medications, psychotherapy and other physical (neurostimulation) therapies. Our TMDS Psychiatrist will discuss these with you. The TMS doctor will also explain why rTMS or deep TMS has been recommended for you. 

For each rTMS session, you will be brought into a specially equipped room. You will be asked to remove any metallic or magnetic objects. During rTMS, you will be required to wear earplugs or headphones for your comfort and safety. You will be awake during the whole procedure: rTMS does not require any anaesthesia or sedation. You can drive after your treatment.   During the rTMS treatment, a magnetic coil will be placed against your head. The sensation of having rTMS varies for different people. You are likely to feel a tapping on the scalp at the site of stimulation, intermittent tensing of facial muscles and hear a clicking noise of the machine delivering the stimulation. During the procedure, you will be monitored by TMS practitioner (senior nurse trained in rTMS) . You may ask to stop the procedure at any time. In the first session, our TMS Psychiatrist will measure the level of rTMS stimulation you require (brain mapping) and determine a treatment site. Generally, this only needs to be done once but, in some cases, need to be repeated. The rTMS therapy involves a series of treatments. 

The TMS Psychiatrist will discuss with you the number and frequency of treatments and the duration of the treatment course. The exact number of treatments you will need cannot be predicted ahead of time. The number of treatments received will depend on your psychiatric condition, your response to treatment and the medical judgement of the TMS psychiatrist. A treatment course typically involves up to 30 sessions. rTMS sessions are usually administered daily (five times per week), but the frequency of treatments may vary depending on your needs. You may choose to withdraw from rTMS treatment at any time.   Medicare is allowing up to 35 sessions for the initial course and addition 15 sessions for eligible patients (response to initial course but relapsed at least 4 months after the initial course).  

As with any medical treatment, rTMS carries a risk of side effects. However, the risk of serious side effects is rare and rTMS is generally well tolerated.    There are no known long term adverse effects reported with the use of rTMS. However, as this is a relatively new treatment, there might be unforeseen risks that are currently unknown.

There are case reports of pregnant women safely receiving rTMS treatment without detrimental effects to the foetus, but overall, there is little data on the effects of rTMS in pregnant women. It is essential that the TMS Clinic doctor knows if you are pregnant.  

rTMS poses special risks to anyone who has non-removable magnetic metal in their head or upper body. This includes cochlear implants, cerebral aneurysm clips or coils, stents in your neck or brain, implanted stimulators, cardiac pacemakers or implantable cardioverter defibrillators (ICDs), cardiac stents, electrodes to monitor your brain activity, metallic implants in your ears or eyes, bullet fragments, facial tattoos with metallic or magnetic sensitive-ink, other metal devices implanted in or near your head.

We will discuss your medical history and you should inform about past illnesses such as encephalitis or illness that has caused brain injury, stroke, epilepsy or seizures, tinnitus (ringing in ears), adverse reaction to TMS, head injury, neurosurgery, and severe headaches.  

Generally, it has been found that people can drive safely after receiving TMS treatment. However, as it is possible that you may have significant side effects (eg headache), it is recommended that you do not make arrangements to drive immediately (i.e. within an hour) after the first treatment session. After this, if you feel well after TMS treatment, you may drive. The same approach is recommended for operation of machinery. Notify clinic staff if you are not feeling well. 

During the rTMS course, you should keep seeing your own regular treating doctor (Psychiatrist or GP) to continue to monitor/treat you as usual and provide ongoing care after you have finished the course. We will communicate with this doctor to inform them about your involvement with the rTMS treatment. We do not take over your clinical care before, during or after the course. We will monitor your response to rTMS during and after the course.

We will monitor your progress during your treatment and will provide with scales helping us to assess your response to treatment. There is no additional cost for these tests.

You should feel free to ask questions to the TMS Clinic staff at this time or any time during the course of your treatment. Your decision to receive rTMS is being made on a voluntary basis and you are free to withdraw your consent and to discontinue treatment at any time.