For the vast majority of people, there is no risk associated with treatment with rTMS. The most common side effect is a mild headache that can last for several hours after treatment. This is because not only the brain is stimulated, but also the nerves and muscles on the skull. It feels like static electricity; a slight tingling sensation. Some people might find that uncomfortable. The body quickly gets used to it, and after a few sessions most people don’t feel it anymore. It may help to use paracetamol for the first few sessions when a headache occurs. Another side effect that occurs in some cases is mild fatigue, lasting up to a few hours after the end of the session.

The opposite has also been reported: A small group of people experience a hyperactive, energetic state with an elevated mood after treatment, actually the opposite of depression. The most serious side effect that can occur is the occurrence of an epileptic seizure during treatment. This has been reported in 1 in 10,000 patients. In comparison: the risk of an epileptic seizure when using antidepressants is 1 to 3 in 1000 (Source: rTMS Clinic Canada). It has never happened at Neurowave that rTMS leads to an epileptic seizures after treatment. Low-frequency rTMS treatment even seems to have a protective effect in epilepsy and is currently being further investigated for that indication. Nevertheless, we treat according to internationally accepted safety guidelines, and we do not treat patients who are familiar with epilepsy.

rTMS has the advantage that there are few or no side effects. Most medicines do have side effects. Medications also often have to be used for a long time and relapse may occur when the medication is discontinued. ECT, a widely used and effective method for severe depression, has serious side effects, such as memory loss, and problems with attention and concentration. In addition, ECT requires general anesthesia. This is not the case with rTMS. After treatment it is usually possible to resume normal activities or work.

Another advantage is that the treatment lasts relatively short (10-12 weeks) and shows rapid improvement (people who benefit from rTMS often notice improvement within 10 sessions).

The disadvantage is that a relapse can occur after discontinuing treatment. We are currently investigating how the risk of this can be minimised. Examples include maintenance sessions (booster sessions). In any case, we advise people to take measures to prevent relapse. The psychologist helps with a relapse prevention plan. During treatment, attention is paid to factors that cause stress and tension, and a start is made on changing habits that can perpetuate depression. Another drawback for some may be the frequency of treatment: it is really necessary to follow at least two sessions a week for ten weeks.

Of course. You will be guided by us. Research shows that rTMS is most effective when the treatment is combined with a form of psychotherapy (e.g. Donse et al 2017). The treatment is therefore carried out by a (GZ-)psychologist. They have extensive experience in treating people with depression and related problems, and can use various therapeutic techniques, such as cognitive behavioral therapy (CBT), schema therapy, and mindfulness. This therapy takes place simultaneously with the rTMS. So you can always tell your story to the psychologist and you are never alone during the rTMS stimulation.

No, just like medication and psychotherapy, rTMS does not help everyone. Unfortunately, we cannot yet accurately predict who will benefit from the treatment and who will not. We can say that rTMS has been well researched and is recognized as an effective and safe treatment for depression by, among others, the Dutch Healthcare Authority (Nederlandse Zorgautoriteit) They advise health insurers in the Netherlands on the reimbursement of therapies. rTMS has been extensively researched by scientists for effectiveness and safety. Studies report success rates as high as 66%. By way of comparison: with antidepressants this is about 30%.

If there is insufficient effect after the first 10 sessions, we switch to a different treatment protocol. This involves stimulating successively on two points of the head, on both sides with a different frequency. This slightly increases the chance of side effects, but possibly also the chance of improvement.

We inform you well in advance about factors that influence the chance of success. Current abuse of alcohol or drugs, and use of benzodiazepines stands in the way of effect of treatment. We advise people who have many other symptoms in addition to their depression, such as untreated trauma, severe suicidality, or a serious personality disorder, to seek treatment for those symptoms first. If necessary, you can still start with rTMS afterwards.

Usually yes. Always discuss this with your own practitioner. Of course we like to think along with your practitioner to treat complex problems and multiple diagnoses as optimally as possible in consultation.

There are more and more scientific studies showing that rTMS is safe to use during pregnancy. For that reason, pregnancy is no longer a contraindication.