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MENTAL HEALTH

Repetitive Transcranial Magnetic (rTMS)

- Neuromodulation treatment for Depression

Dr. Nikhila Deshpande

Founding Director and
Senior Consultant Psychiatrist

Abstract: cortex). It enhances neuroplasticity of
thalamocortical circuits. This is the area
Repetitive Transcranial Magnetic stimulation which is involved in depression and anxiety. magnetic stimulation (rTMS) for treating major
(rTMS) is a non -invasive, medication free rTMS enhances synaptic plasticity. It changes depression: a systematic review and meta-analysis
neuro-modulatory treatment which is in blood flow and metabolism at the site of the of randomized, double-blind and sham-controlled
providing a ray of hope for the patients stimulation. rTMS also increases grey matter trials. Psychol Med 2014; 44: 225–39. 10.1017/
suffering from depression and anxiety volume. It also affects BDNF upregulation. S0033291713000512
disorders. rTMS has proven successful in
treating treatment resistant depression as Indications: Connolly KR, Helmer A, Cristancho MA, Cristancho
well as drug naive cohort. P, O’Reardon JP. Effectiveness of transcranial
Depression, Bipolar depression, Post -partum magnetic stimulation in clinical practice post-FDA
Introduction: depression. Depression associated with approval in the United States: results observed
Fibromyalgia, chronic pain etc., Generalised with the first 100 consecutive cases of depression at
Repetitive Transcranial Magnetic (rTMS) is anxiety disorder, Obsessive compulsive academic medical centre. J Clin Psychiatry. 2012;
the cutting-edge treatment for depression disorder. Apr,73(4): e567-73.doi; 10.4088/JCP.11M0743.
and anxiety. NICE has approved rTMS for
depression treatment in 2015. The Royal Side effects: Dunner DL, Aaronson ST, Sackeim HA et al. A
college of psychiatrists recommended it in multisite, naturalistic, observational study of
transcranial magnetic stimulation for patients
2017. rTMS has been used worldwide at least This treatment has minimal side effects most with pharmacoresistant major depressive
over a decade with good success results. FDA common being headache and facial twitches disorder: durability of benefit over a 1-year
has recently approved rTMS for Obsessive during the treatment being the most common. follow-up period. J Clin Psychiatry. 2014
Compulsive Disorder. Other side effects are as follows- Dec;75(12):1394-401.
• Discomfort at the site of stimulation and NICE-https://www.nice.org.uk/guidance/ipg542.
Until now, the traditional mode of treatment scalp discomfort, www.tranquiltms.co.uk
for depression was psychopharmacology • Transient hearing loss
mainly antidepressants, ECT in severe cases • Neck pain,
Author Information
and psychological therapy. There was still a • Occasional agitation or increased suicidal
Dr Nikhila Deshpande is the Founding Director
part of population who was failing to respond ideas
and Senior Consultant Psychiatrist. She has
to all these treatment options. • Rare episode of hypomania especially in
been working in the field of psychiatry since
To this disadvantaged group, neuromodulation patients with Bipolar disorder.
1993. She has extensive experience in managing
therapies like rTMS can be offered now. • Rare side effect of seizure (1 in 30,000).
various psychiatric conditions affecting adults
Looking at various RCTs, rTMS has now a over the age of 18. Dr Deshpande is particularly
place in the treatment depression specially to Success rate: passionate about diagnosis and management of
treat treatment resistant depression (Dunner mental illnesses such as depression, anxiety and
et al,2014). Our (Tranquil TMS clinic) recent audit dementia. She has published several papers and
showed that our clinic’s remission rates for has participated in research projects. She is an
Advantages: Depression with rTMS was high (37.03%) examiner for the MRCPsych exams for The Royal
and comparable to a study done by Connolly College of Psychiatrists. She founded Tranquil
rTMS is quick to work. It’s a medication et al in 2012 which showed a remission rate TMS to provide a safe and non-invasive treatment
free treatment. It is non- invasive and cost- of 35.3%. for depression and anxiety that works. She has
effective treatment. This can be combined However, our response rate of 66.66% was completed rTMS training course successfully
organised by Clinical TMS society which is an
safely with antidepressants. Patients can higher than the response rate of 41.2%
international organisation. Dr. Deshpande is also
come driving. Their routine is unchanged. quoted in the same study and higher than the
a member of clinical TMS society.
results of a meta -analysis done by Berlim et
How does rTMS works? al in 2014.
Repetitive transcranial magnetic stimulation
works on Faraday’s law. A magnetic coil is Discussion:
placed on the head and magnetic pulses are
delivered to the brain which creates electrical In conclusion, this novel treatment has
field which in turn stimulates nerve cells an important place in the management of
in that part of the brain. Magnetic impulses depression and anxiety disorders. At present,
travel 2-3 cm wide and down the brain this treatment is mainly available in private
-targeted point. These impulses generate sectors though few NHS centers are offering
electric current which in turns stimulates rTMS on the NHS.
under preforming nerve cells in the localized
areas. References:
rTMS works by stimulation of Berlim MT, Van Den Eynde F, Tovar-Perdomo S,
underperforming nerve cells which controls et al. Response, remission and drop-out rates
mood and emotions (Dorsolateral prefrontal following high-frequency repetitive transcranial

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