rTMS - Centre for Neuromodulation

Why rTMS?

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.

Background

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)

I do not live locally, can I still access TMS treatment with you?

Yes, we can offer TMS treatment to people that do not live in Northamptonshire. You can either self-fund your treatment or seek funding from your local Clinical Commissioning Group (CCG). We would recommend that you contact us to discuss this, and we will be happy answer any questions you may have.

What happens once you receive my referral?

All referrals made to our service are screened for suitability for TMS treatment weekly by the clinical team. Once your referral has been screened, we will contact you to arrange an initial assessment. Initial assessments typically take place on either a Monday or a Tuesday and will be with one of our two consultant psychiatrists and a member of the clinical team.

If you do not live locally and are being funded by your local Clinical Commissioning Group (CCG), we will contact you to arrange your assessment once written confirmation of funding has been received. If you have access to a computer and live far we may be able to conduct your initial assessment via Microsoft Teams.

You will also be invited to a pre treatment clinic held at the CfN whereby you will meet with a member of the clinical team. During this appointment, you will be introduced to the clinical team and the treatment process and will have the opportunity to ask any questions.

What happens after my assessment?

Following your assessment, we will contact you to arrange your TMS treatment. Please be aware that there may be a period of time between your assessment and starting TMS treatment.

If you do not live locally and are being funded by your Clinical Commissioning Group (CCG), we will inform them of the treatment plan you have been recommended and advise them of the cost of this. Once we have received confirmation from them that the funding has been authorised, we will contact you to arrange your TMS treatment.

Am I able to bring my child(ren) with me to my 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 can wait with an accompanying adult elsewhere on the Berrywood Hospital site. 

Will the consultant at the Centre for Neuromodulation 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. 

Do I stop taking my prescribed antidepressant medication(s) once treatment has finished?

No.  You should continue to take medication(s) as prescribed by your responsible clinician until advised otherwise.

Where do I seek support from once my treatment has finished?

We are a treatment only service and therefore if you require support after your TMS has finished, please contact your local CMHT.

At the end of your treatment a Treatment Summary letter will be composed by your named nurse here at the Centre for Neuromodulation and sent to yourself and your referring team. Within this summary it will detail whether you have responded to TMS and advise your Responsible Clinician to review your care.

We also offer a support group which runs once a month and is led by the Chaplaincy service here at NHFT. This peer support group is available for those waiting for assessment/treatment, those who are undergoing treatment and those who have finished their course of treatment. It is an opportunity to meet other people that are or have had TMS treatment and seek peer support. Details of dates and times are available at the Centre and can also be provided upon request.

Will I be able to return to the service for more treatment in the future?

Discharge planning is something that you will work together with your named nurse once you commence treatment. The hope is that one course of rTMS treatment will be effective in managing your symptoms and there may not be a need to return for more treatment in the future. Depending on your response a decision will be made together with your name nurse about future access to the service.

Please note that if more than 12 months has elapsed since your last treatment you may be required to have a re-assessment with one of our consultants.

Are there any safety precautions with rTMS?

A mild headache and skin irritation can be a side effect of TMS. In this instance, we would suggest you use your usual pain killer. If this fails to offer relief and your symptoms persist, it is unlikely to be as a result of rTMS and we would encourage you to contact your GP or 111 for support.

Ear plugs must be worn as a precaution during treatment to protect the ears from the clicking sounds the machine makes.

Please be open and honest on your screening form and make us aware of any additional needs you may have, including any mental and physical health conditions. This is important so that we can tailor the treatment to your individual needs.

Where can I access support out of hours?

As we are a treatment only service operating 7am – 3pm Monday to Friday, in a crisis please contact your local CMHT for support. Other available services are listed below:

Integrated Mental Health Hub: 0800 448 0828

Samaritans: 116 123 Open 24 hours a day, 365 days a year

CALM: 0800 58 58 58 Open 5PM-Midnight, 365 days a year

SHOUT, Text Messaging Support Service: 85258