Depression

Depression is a serious mental disorder that is not only about thoughts and emotions, but also involves changes in brain function.

In prolonged depression, reduced activity is often seen in parts of the brain that are central to energy, motivation, concentration, and the ability to experience pleasure (particularly the left prefrontal cortex). At the same time, increased activity is often observed in more emotional and stress-related brain regions involved in negative emotional processing.

In practice, this imbalance means that the brain generates negative thoughts and emotions to an excessive degree and loses the ability to regulate them. The result is persistent low mood, fatigue, reduced initiative, and at times cognitive difficulties – even when there is objectively no acute problem in the surroundings.

Treatment of depression with rTMS – how it works and what to expect

rTMS (repetitive transcranial magnetic stimulation) is a brain-based treatment delivered via a magnetic coil placed over the forehead, with the aim of increasing activity in brain areas that are underactive in depression and thereby helping to restore balance in the brain’s regulatory systems.

In the treatment of depression, stimulation typically targets the left prefrontal cortex, an area that is often underactive in depression. Repeated stimulation over several weeks can increase activity in this region and contribute to more effective regulation of the neural circuits involved in mood, energy, and cognition.

Treatment takes place at the clinic. You sit in a chair, remain awake throughout the session, and can go straight home afterwards. A session can last from a few minutes up to 40 minutes depending on the chosen stimulation protocol, and a full course of treatment most often consists of 30 sessions distributed over six weeks.

Effect and expectations

The vast majority experience the stimulation as completely painless and without discomfort. Typically, a mild tingling sensation is felt on the skin beneath the magnetic coil. Some, however, experience this sensation as uncomfortable or painful, which usually decreases after a period of adaptation.

For many patients, rTMS leads to a gradual reduction in depressive symptoms until the full course of treatment is completed. After 10–15 sessions, many experience increased energy, improved mood, better concentration, and greater mental clarity. The effect builds over time and rarely appears after only a few treatments, as the aim of the therapy is to help the brain regain regulatory capacity—this process is known as neuroplasticity and is inherently slow.

The evidence for rTMS in depression is strong, particularly in patients who have not achieved sufficient benefit from antidepressant medication. Some experience marked improvement, others a more moderate effect, and a smaller group experience no significant benefit.

Side effects are usually very mild and short-lived, most commonly mild headache or slight discomfort during stimulation.

Compared with other treatment approaches for depression

Depression is typically treated with a combination of:

  • Antidepressant medication (e.g. SSRIs, SNRIs, or TCAs)

  • Psychotherapy, particularly cognitive behavioural therapy

  • Psychological counselling in psychiatric services or with a private psychologist

  • ECT (electroconvulsive therapy) for severe or life-threatening depression

Many benefit greatly from these treatments, but not everyone. Some experience insufficient effect or significant side effects.

ECT is usually very effective, but requires hospitalisation, is considerably more invasive, and consistently involves more side effects.

rTMS positions itself between these treatments: less invasive than ECT, yet with documented effectiveness and minimal side effects.