An estimated 20-40% of people with depression do not feel better or recover following existing standard treatments. The main treatment for those with drespression is antidepressant medication, however not everyone who takes this will respond in a positive way - this is called treatment resistant depression (TRD1). Neuromodulation in the treatment of TRD can make significant improvements to how you might be feeling.
In England, the National Institute for Health and Care Excellence (NICE 2015) issued guidance for the use of rTMS recommending it as a treatment for depression.
There are still only a handful of clincis who are able to offer rTMS in the UK, and here at the NHFT's Centre for Neuromodulation we are one of them.
In 2008, rTMS was approved by the United States Food and Drug Administration (FDA) for treatment of patients suffering from treatment resistant depression. rTMS has been extensively used in the United States since 2008 and is also used in many countries within Europe as well as Australia, China and Japan.
Professor O’Neill-Kerr, who works at NHFT, co-wrote the Royal College of Psychiatry position statement on rTMS (2017) which recommends ‘rTMS is now an established safe and effective treatment option for treatment resistant depression.’ In 2018 Professor O’Neill-Kerr co-wrote the amended position statement for the RCPSych to read that a qualified rTMS Technician or equivalent with adequate training and competencies can administer the rTMS and monitor for side effects during the treatment.
Our Centre for Neuromodulation is also able to facilitate quantitative EEG mapping via a private clinic in London for a small charge; this provides patients the opportunity to receive targeted bespoke TMS, maximising the effectiveness of the treatment sessions. This may be of particular benefit to patients with restricted availability
The rTMS process
All patients undergo a thorough assessment with one of rTMS consultants in the department at which time consent will be taken and a prescription created.
A patient’s age can be a factor in determining which protocols can be used. Sometimes the doctors will take the decision to amend the prescription part way through the course of treatment depending on the individual tolerance and response.
The procedure involves placement of an electromagnetic coil to deliver a burst of magnetic energy (1.5 Tesla) through the scalp to induce neurons in the outer 1cm of the brain tissue to fire. rTMS is a relatively new treatment modality for psychiatric disorders in the UK, however is already well established in neuroscience and as a treatment for depression and anxiety in other countries.
Each treatment lasts around 40 minutes or less depending upon the protocol being used. TMS is administered on a daily basis for approximately 4 to 6 weeks. For patients travelling from outside the local area, there are protocols that can be used up to 3 times per day thus reducing the whole course time; however this will be discussed with the doctor before being prescribed. During treatment, a series of clicking sounds can be heard and a sensation of tapping can be felt on the head underneath the coil. Ear plugs are offered to all patients.
Frequently asked questions (FAQs)
Am I able to pay privately for an assessment?
Yes. Any patient in any locality is able to choose to pay the assessment fee should they wish to do so. We will require written confirmation of your intention to self-fund. This can be in the form of an email.
Am I able to being my child/children with me to appointments at the Centre for Neuromodulation?
We aim to provide a quiet environment for our patients to undergo assessment and treatment therefore, unfortunately, the Centre for Neuromodulation operates a strict ‘no children’ policy. However children are able to wait with an accompanying adult elsewhere on the Berrywood Hospital site.
Will I undergo reviews with a Consultant?
Yes. Clinical reviews are undertaken at the middle and end points of your initial course of treatment following which relevant information relating to your progress and treatment will be sent to your responsible clinician. Should any amendments to your treatment plan be required, they will be discussed with you at these times.
Will the Consultant at Centre for Neuromodulation (CfN) make changes to my medication?
The Consultant at the CfN is responsible for the prescribing of TMS treatment only. Your responsible clinician in your local area will retain this responsibility for your ongoing care and management.
Where do I seek support from once my treatment has finished?
Should you require support once your treatment has ended, please contact the clinician or team responsible for your care and management within your locality. This could be your GP, your Consultant Psychiatrist (should you be seeing one) or your local Mental Health Services.
The CfN runs a support group once a month for those waiting for assessment/treatment, those who are undergoing treatment as well as those who have finished their course of treatment. Details of dates and times are visible within the CfN; however can also be provided upon request.
Do I stop taking my prescribed antidepressant medications once treatment has finished?
No. You should continue to take medication(s) as prescribed by your responsible clinician until advised otherwise.