rTMS vs. TMS: What’s the Difference in Depression Treatment?

Navigating depression treatment options can be overwhelming, especially when terms like TMS and rTMS are thrown around. Are they the same? How do they help with depression, particularly treatment-resistant depression (TRD)? Telehealth providers in Australia, like Mind Connections Specialist Health Services, offer these therapies, but understanding their differences is key to making informed choices. This blog breaks down Transcranial Magnetic Stimulation (TMS) and Repetitive Transcranial Magnetic Stimulation (rTMS), their roles in depression care, and what to expect, all backed by peer-reviewed research.

What Is TMS?

Transcranial Magnetic Stimulation (TMS) is a non-invasive therapy that uses magnetic fields to stimulate nerve cells in the brain. Developed in 1985, it’s primarily used to treat mental health conditions like major depressive disorder (MDD), especially when medications or psychotherapy haven’t worked. TMS involves a magnetic coil placed against the scalp, typically targeting the dorsolateral prefrontal cortex (DLPFC), a brain region linked to mood regulation. A single pulse or short series of pulses is delivered to influence brain activity.

TMS is often used in research to explore brain functions or as a diagnostic tool, such as measuring motor cortex activity for neurological conditions like multiple sclerosis. For depression, however, it’s less common as a standalone treatment compared to its repetitive form, rTMS.

Key Features of TMS:

Non-invasive, requiring no surgery or anesthesia.
Single or paired pulses, often for diagnostic or experimental purposes.
FDA-approved since 2008 for depression in the U.S., available in Australia.

>> Related Post: Best Depression Treatments/Therapy in Sydney

BOOK ONLINE APPOINTMENT

What Is rTMS?

Repetitive Transcranial Magnetic Stimulation (rTMS) is a specific type of TMS where multiple magnetic pulses are delivered in rapid succession to create longer-lasting changes in brain activity. It’s the most common form of TMS used clinically for depression, particularly TRD, where patients haven’t responded to at least one antidepressant. rTMS targets the left DLPFC with high-frequency pulses (≥5 Hz) to excite neural activity or the right DLPFC with low-frequency pulses (≤1 Hz) to inhibit it, based on research showing frontal lobe asymmetry in depression.

rTMS sessions last 20–40 minutes, typically 5 days a week for 4–6 weeks, totaling 30 treatments. Studies show 50–55% of patients respond (50% symptom reduction), with 30–35% achieving remission.

Key Features of rTMS:

Delivers thousands of pulses per session for therapeutic effect.
Proven effective for TRD, with remission rates up to 40% in some studies.
Minimal side effects, like mild headaches, that fade over time.

rTMS vs. TMS: The Key Differences

While TMS and rTMS use the same magnetic stimulation technology, their application and purpose differ significantly:

Pulse Delivery: TMS uses single or paired pulses, mainly for research or diagnostics. rTMS uses repetitive pulses (thousands per session) for therapeutic effects in depression.
Clinical Use: TMS is less common for depression treatment; rTMS is the standard, FDA-approved protocol for TRD since 2008.
Effect Duration: TMS effects are short-lived, used to study brain activity. rTMS creates longer-lasting neural changes, improving mood over weeks.
Session Structure: TMS sessions are brief and varied; rTMS follows a structured 4–6-week course with daily sessions.

How Does rTMS Compare to Other Treatments?

rTMS Treatment is often compared to electroconvulsive therapy (ECT), another brain stimulation treatment for severe depression. Unlike ECT, which requires anesthesia and induces seizures, rTMS is non-invasive, outpatient, and has fewer side effects (no memory loss). Studies show ECT is more effective for severe cases, with a 6-point greater reduction on the Hamilton Depression Rating Scale, but rTMS is preferred for TRD due to its safety and convenience.

Compared to antidepressants, rTMS offers an alternative for those with intolerable side effects or non-response. It can also complement medications or therapy, enhancing outcomes. Costs in Australia range from $6,000 to $12,000 for a full course, with some insurance coverage available.

Why Choose rTMS?

Safe, with rare risks like seizures (<1%).
Outpatient procedure; resume normal activities immediately.
Effective for TRD, especially after 1–2 failed antidepressant trials.

FAQs

1. Is rTMS the same as TMS?

No, rTMS is a repetitive form of TMS used for depression treatment, delivering thousands of pulses per session, while TMS is often for research or diagnostics.

2. Who is rTMS best for?

It’s ideal for adults with TRD who haven’t responded to at least one antidepressant or experience severe medication side effects.

3. Are there side effects?

Common side effects include mild headaches or scalp discomfort, which typically lessen after initial sessions. Seizures are rare.

4. Is rTMS covered by Medicare?

In Australia, Medicare may cover rTMS for TRD with a specialist referral.

5. How long do rTMS effects last?

Benefits can last months to a year; maintenance sessions may be needed for 40% of patients within 3 months.