Repetitive Transcranial Magnetic Stimulation: What Is It, Effects and Does It Work?

Keegan Warrington
October 8, 2021

Transcranial Magnetic Stimulation or TMS is a non-surgical and non-invasive treatment for mental health problems like depression and anxiety. There are three main kinds of TMS treatments: single-pulse, paired-pulse, and repetitive TMS. This article will focus on rTMS, its procedures, and its overall benefits for mental health patients.

What is Repetitive Transcranial Magnetic Stimulation?

rTMS is a procedure that uses magnetic pulses to target specific areas of the brain. The human brain produces waves which ir proof of the presence of electrical activity inside it. When a person experiences mental health illnesses like depression and anxiety, brain waves tend to be slow or not in their normal ranges but not necessarily abnormal.

In a paper titled Transcranial magnetic stimulation for the treatment of anxiety disorder by Priscila Aparecida Rodrigues, Ana Luiza Zaninotto, Iuri Santana Neville, et al., the authors of this study of repetitive transcranial magnetic stimulation defined this procedure as a “therapeutic option for neuropsychiatric dysfunctions.”

With rTMS, the magnetic pulses aim to stimulate brain activity and help the brain waves flow normally. Though studies show that rTMS helps patients with mental illnesses, it is not the first line of treatment. Moreover, patients can’t automatically ask therapists to enroll them on TMS. There are specific reasons why rTMS is used only as a secondary treatment. Let’s check out these reasons in the next section.

Why is rTMS Used?

As explained earlier, rTMS is not a primary treatment for depression and anxiety. Psychiatrists only consider TMS when the situation calls for it. Here are three common reasons why rTMS is used in treating mental health problems.

    1. Clinical mental health treatments aren’t working.

In normal psychiatric treatments, patients undergo counseling coupled with drugs that alter the brain’s functioning process. Counseling helps the patient psychologically. On the other hand, drugs help patients get better while dealing with their issues, traumas, and trigger points.

Antidepressants, for example, keep patients from feeling gloomy, which could trigger their depressive tendencies. With antidepressants altering the brain’s activity, patients can return to their social life and establish stronger relationships with other people.

Repetitive transcranial magnetic stimulation is advised when the patient isn’t responding to clinical treatments and has used at least one antidepressant.

Repetitive Transcranial Magnetic Stimulation Side Effects
    2. The patient isn’t qualified for electroconvulsive therapy.

Electroconvulsive therapy (ECT) is a similar treatment with rTMS, but ECT uses electrical currents instead of magnetic pulses. ECT administers carefully controlled electric currents to induce a seizure.

Unfortunately, using ECT is for patients with optimum health. You are not eligible for ECT depending on some health-specific qualities like the following:

  • The patient has a history of seizures
  • The patient can’t tolerate anesthesia
    3. It is used to augment psychotherapy and medications.

Some patients may undergo repetitive transcranial magnetic stimulation to augment psychotherapy. rTMS can help improve the effectiveness of clinical treatments. Unlike in the first number, treatments have become ineffective. In this case, clinical treatments are working though not effectively.

A typical scenario why patients undergo rTMS while under psychotherapy is because they’re recovering from substance abuse. Drugs given to these patients are so mild that it doesn’t provide the same sensation as being “high.” Hence, rTMS can help yield better results.

Who is not Qualified for rTMS?

You are not an ideal candidate for the rTMS if you have the following:

  • Implants for aneurysm
  • Fragments from bullets or shrapnels near the head
  • Pacemakers or implantable cardioverter defibrillators (ICD)
  • Facial tattoos that used magnetic ink
  • Stimulators
  • Metal implants near the eyes
  • Neck or brain stents

How Does the rTMS Procedure Work?

The rTMS therapy usually takes around 30 to 60 minutes. Before rTMS treatment, you can expect the technologist to give you a quick explanation of the treatment. The frequency of rTMS will depend on the attending psychiatrist.

Here’s what will happen during rTMS:

  1. rTMS doesn’t require sedation or general anesthesia. Patients are fully awake during the procedure.
  2. The technologist or attending doctor will let you sit down. You’ll be reclined at a certain angle so that the technologist can easily manipulate the apparatus on your head.
  3. Earplugs will be provided to help ease the vibration of the machine. Insert them properly in your ears.
  4. Once ready, the technologist will place an electromagnetic conductor near your head. The conductor may feel cold to touch, so don’t be too alarmed if you feel that way.
  5. Before the actual procedure, the psychiatrist and technologist have talked about the positioning of the electromagnetic coil. The positioning is crucial since you want the pulses to target a specific part of the brain. Also, expect the technologist to place the rTMS machine at different portions of the head. The psychiatrist may want to target particular parts of the brain depending on your diagnosis.
  6. During the procedure, you’ll feel no pain. However, you’ll feel a knocking or tapping sensation on the head. Don’t hesitate to tell the technologist if the tapping feels uncomfortable. More so, speak up immediately if there is pain.

After the treatment, you may go straight home and drive. There is no “recovery time” after the treatment. However, if you feel some side effects, the technologist might let you stay in the laboratory for several minutes.

rTMS Side Effects and Complications

Most patients report mild discomfort during and after the therapy. However, it is not life-threatening. Other known side effects of repetitive transcranial magnetic stimulation include the following:

  • Feelings of lightheadedness
  • Hearing problems such as a resonating magnet noise
  • Mild headaches
  • Tingling sensation in the face, jaw, or scalp
  • Facial twitching
  • Scalp sensations

There are also no known major complications for rTMS. The risk of seizures is low and rare for rTMS therapy.

Cost of rTMS

Laboratories and hospitals have varied costs for rTMS. The average price for rTMS ranges from $230 to $340 per session. You must talk with your insurance provider to find out if rTMS is covered. If your insurance doesn’t cover rTMS, you may further coordinate with the hospital or lab for discounted programs or flexible payment schemes.


Repetitive transcranial magnetic stimulation is a painless treatment used to help patients with mental health disorders. Though not a first-line treatment, it can help augment or improve the patient’s recovery. Check out if you’re a good candidate for this treatment. Here at Roots TMS, we’re all about helping people improve their well-being and regain control of their lives. Schedule an appointment with us now to get started.

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Keegan Warrington