What is rTMS therapy?

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation therapy that uses magnetic pulses to activate specific areas of the brain through a coil placed on the scalp (Pateraki G et al., 2022). These magnetic pulses pass through the skull and affect the electrical activity of neurons in targeted brain regions associated with depression, anxiety, chronic pain, and other disorders (Aceves-Serrano L et al., 2022).

It is approved for the treatment of medication-resistant depression—cases where medication has not produced the desired results—as well as other conditions such as chronic pain, migraines, tinnitus, stroke recovery, and anxiety disorders (Aceves-Serrano L et al., 2022; Thanki M et al., 2024). rTMS does not involve medication or require anesthesia during administration. It is a scientifically validated alternative for individuals seeking treatment without the side effects of drugs.

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  • Depression (Thanki M et al., 2024)
  • Anxiety Disorders (Thanki M et al., 2024)
  • Obsessive-Compulsive Disorder (OCD) (Mann SK et al., 2023)
  • Chronic Pain (Mann SK et al., 2023)
  • Post-stroke Rehabilitation (Aceves-Serrano L et al., 2022)
  • Parkinson’s Disease (Pateraki G et al., 2022)

In which conditions can rTMS help?

How the treatment is done

During the first rTMS session, the patient wears a special cap through which the necessary measurements are taken to identify the exact stimulation site and ensure proper coil placement. The patient sits comfortably in a chair while the magnetic coil is positioned on the head according to the treatment target area. The healthcare professional adjusts the device to deliver a series of pulses to determine the energy level required to trigger a muscle contraction in the patient’s hand (Chail A et al., 2018).

This energy level—called the motor threshold—varies from person to person and represents the minimum energy needed to induce a thumb twitch. This measurement helps the clinician tailor the treatment settings and determine the required stimulation dose for effective brain cell activation.

Once the energy level is determined, the coil is placed gently on the scalp with minimal pressure, without causing discomfort, and the therapy begins. During the procedure, the patient hears a series of clicking sounds and may feel a light tapping sensation at the site of coil placement.

The machine delivers short, repetitive magnetic pulses to the brain at a frequency and intensity customized by the clinician based on the patient’s needs, stimulating neural activity in targeted areas. For added comfort and hearing protection, the patient wears earplugs, as each pulse produces a clicking sound.

Frequency and Duration of Treatment

Most patients need 10–30 sessions, typically conducted daily (Monday–Friday) over several weeks, depending on individual needs. The number and frequency of sessions are adjusted based on the patient’s response to treatment. Sessions last about 20–40 minutes, and the patient remains awake and comfortable throughout.

Possible Risks and Side Effects

rTMS is generally a safe and non-invasive method that does not cause pain. Common and mild side effects include:

  • Mild headache – usually temporary and resolves after a few sessions (McClintock SM et al., 2018)
  • Discomfort or pressure at the application site (McClintock SM et al., 2018)
  • Fatigue or drowsiness after a session
  • Increased nervousness or overstimulation

Rarely, patients may experience:

  • Dizziness or nausea (McClintock SM et al., 2018)
  • Seizures – very rare (less than 0.1%)

Contraindications and Precautions

rTMS should not be used in individuals who have:

  • Metal implants or pacemakers near the skull (McClintock SM et al., 2018)
  • Active epilepsy without medical supervision (Mann SK et al., 2023)
  • Severe traumatic brain injury or brain aneurysms
  • Pregnancy

A complete medical history will be taken by the healthcare provider before starting treatment.

What to Expect

Before Treatment:

  • An initial assessment is conducted to determine if rTMS is suitable
  • A personalized treatment plan is created

During Treatment:

  • You will sit comfortably while the equipment is positioned on your head
  • Remove metal objects such as mobile phones, smartwatches, jewelry, and wallets
  • You will wear earplugs to protect your hearing during the session
  • You may feel a light tapping or vibration on your scalp
  • No anesthesia is required, and you can continue your day normally afterward

After Treatment:

  • No recovery time is needed
  • Improvement is usually gradual and appears over several sessions

Practical Guidelines for Patients

  • No special preparation is required, but it is best to avoid sleeping just before the session
  • You can return to your daily activities immediately after the session
  • Inform your doctor about any changes in your health or medications
  • If you experience discomfort, headache, or mood changes, notify your healthcare provider
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