Depression ECT and rTMS

I saw a post on Facebook, offering treatment for depression (at around £8’000). What the company is offering is an innovative depression treatment, without medication, called > rTMS.

Major depressive disorder (MDD) has a lifetime prevalence of nearly 15% in higher-income countries(1) and is associated with substantial mortality and morbidity. The World Health Organisation (WHO) estimates that 350 million people, of all ages, suffer from depression, which is the leading cause of disability worldwide… and top money making drugs (Aripiprazole) for the Big Pharma [2.6% of the adult population of the UK suffer from depression of some kind. This equates to over 1 million people].

rTMS stands for “repetitive transcranial magnetic stimulation.” It is a non-invasive approved medical procedure for the treatment of depression in adults. There are various types of TMS, including single-pulse TMS, which delivers one pulse at a time, and repetitive TMS (rTMS), in which repeated pulses are administered to the same area.

rTMS is a brain stimulation technique that relies on the generation of brief magnetic fields using an insulated coil that is placed over the scalp. These magnetic fields are the same type and strength as those used in magnetic resonance imaging (MRI) machines.

Some of the alternative treatment options for depression include: medications, psychotherapy, vagus nerve stimulation (VNS), electroconvulsive therapy (ECT), acupuncture, vitamins and supplements.

With ECT, an electric current is briefly applied through the scalp to the brain, inducing a seizure. [Patient is given a muscle relaxant, put to sleep with a general anaesthesia, electrodes are placed on the patient’s scalp, a finely controlled electric current is applied, the current causes a brief seizure in the brain].

High rates of early relapse following ECT are reported in many studies. A 2017 report in the journal Ethical Human Psychology and Psychiatry has fuelled a new call for a ban on the use of electroshock treatment, especially on children and the elderly. And with women historically being electro shocked two to three times that of men, the use of the procedure has been labelled as a form of violence against women. Last year, Citizens Commission on Human Rights International (CCHR), filed more than 8,000 complaints and letters exposing the dangers of ECT.

Current treatment guidelines offer little information to clinicians on the optimal nature of maintenance therapy following ECT. Studies have provided evidence regarding post-ECT relapse. The largest evidence base for efficacy in post-ECT relapse prevention(2) exists for tricyclic antidepressants(3). Published evidence is limited or non-existent for commonly used newer antidepressants or popular augmentation strategies. Maintenance of well-being following successful ECT needs to be improved. [Source, Neuropsychopharmacology. 2013, Nov].

On 19/09/2017, electronic literature (Psychiatry research, NCBI) on maintenance of rTMS for depression was reviewed. A limited number of controlled, open-label studies, as well as case series, have been published on maintenance of rTMS after successful response to acute rTMS. In the majority of these studies, most patients with treatment-resistant unipolar or bipolar depression with or without medications experienced either moderate or marked benefit with maintenance rTMS, sometimes remission for three months and up to eight years. Many of the reviewed studies have shown promising results, however, future well-designed sham-controlled studies are needed to confirm the long-term safety and efficacy of maintenance rTMS in the relapse prevention of depression.

TMS treatment for depression is not provided on the NHS as it is not funded by any clinical commissioning groups (CCGs).

Most treatments, considering 5 sessions, cost £1200/£1800 per week in UK. Continental Europe and USA are about 20% cheaper.



TMS’ side effects are largely unexplored and the limits of safe exposure have not been determined except as regard to the acute production of seizures. Although tissue damage is unlikely, cognitive and other adverse effects have been observed and the possibility of unintended long-term changes in brain function are theoretically possible.

Known risks [Wassermann 1998; Machii et al. 2005]

  • seizure
  • pseudo seizure and syncope
  • headache and neck pain
  • effects on cognition
  • effects on mood
  • endocrine effects
  • auditory effects
  • burns from scalp electrodes
  • psychiatric symptoms
  • nausea
  • transient rise in auditory threshold
  • tinnitus
  • mild high-frequency hearing loss after several weeks of rTMS
  • increase in thyroid-stimulating hormone (TSH)*
  • acute increase in cortisol*
  • increase in glutamate/glutamine*

Theoretical risks [Wassermann 1998; Machii et al. 2005]

  • histotoxicity
  • kindling
  • long-term potentiation
  • long-term depression


  1. The risks of exposure to TMS in pregnancy are unknown.
  2. There may be unforeseen risks in the long-term that are currently unknown.
  3. The main symptom of concern is convulsions. In about 1 in 30,000 sessions, patients can have a generalised convulsion



There’s no single cause of depression. It can occur for a variety of reasons and it has many different triggers. At the heart of them all seem to have a vicious circle of self-disgust and loss of vitality, a kind of shutting down of our system. Some ‘experts’ say it is simply chemical, an imbalance in the brain caused by purely physiological factors or prolonged exposure to the chemical messenger dopamine.

I have pointed out a number of alternative treatments but have not mentioned NLP (Neuro-Linguistic Programming). Many people find the initial premise of NLP liberating – the belief that we are designed to be in control of our lives, and can change both our behaviour and mental states. NLP looks at the way in which non-verbal and verbal communication can affect the way in which our brain processes information – if you keep on doing the same things, you’ll get the same results: therefore to beat depression, you need to make changes in your behaviour.

The idea is that you are, in fact, allowing yourself to be depressed. Our internal process arranges the information by deleting, distorting and generalizing the information thus forming an opinion on said information. Basically everyone will process different situations individually.

When you are exposed to any elements, whether it be verbal or non-verbal, your brain will process them in a certain way. NLP techniques teach you how to look at the situation differently(4). One of the techniques that is used in NLP to combat depression is called “reframing”. This is done by simply changing how you see the situation or by putting a different spin on it (NLP Swish Pattern).


© Copyright –  A B M Procaccini;  Psychologist, Naturopathist


  1. Chronic pain conditions are common in both developed and developing countries. Overall, the prevalence of pain is greater among females and among older persons. Although most persons reporting pain do not meet criteria for a depressive or anxiety disorder, depression/anxiety spectrum disorders are associated with pain in both developed and developing countries. [Journal of Pain – October 2008, Volume 9, Issue 10, Pages 883–891]
  2. Thirty-two studies with up to 2 years’ duration of follow-up were included. In modern era studies of continuation pharmacotherapy, 51.1% (95% CI=44.7–57.4%) of patients relapsed by 12 months following successful initial treatment with ECT, with the majority (37.7%, 95% CI=30.7–45.2%) relapsing within the first 6 months. The 6-month relapse rate was similar in patients treated with continuation ECT (37.2%, 95% CI=23.4–53.5%). In randomized controlled trials, antidepressant medication halved the risk of relapse compared with placebo in the first 6 months (risk ratio=0.49, 95% CI=0.39–0.62, p<0.0001, number needed to treat=3.3). Despite continuation therapy, the risk of relapse within the first year following ECT is substantial, with the period of greatest risk being the first 6 months. [Source: Neuropsychopharmacology. 2013 Nov; 38(12): 2467–2474. Published online 2013 Jul 10]
  3. Tricyclic antidepressants (TCAs) are a class of antidepressant medications that share a similar chemical structure and biological effects. Scientists believe that patients with depression may have an imbalance in neurotransmitters, chemicals that nerves make and use to communicate with other nerves
  4. Bandler NLP – Richard Bandler is in a Psychiatric hospital talking to a patient while the doctor is also there. Text taken from one of his seminars: “And then she looks at me and she goes: ‘You want to see me scare him?’ She said this right in front of him! And I went: ‘Yes, Yes, I’d like to see that!’ She looks at him and she goes: ‘I was talking to the entities last night doc’, and the doctor gets really uncomfortable because there are no entities, and she goes: ‘They said you’d say that’. And he goes: ‘You know if you keep doing this you’re going to have another set of treatments’. And I’m thinking: ‘She’s in a fucking padded cell. What more treatment could you get?’ And I looked at him and said: ‘What treatments?’ And he said: ‘Electric shock treatments!’ By the way, I don’t know who’s idea that was… was there a psychiatrist who was really depressed? He was at home in his workshop making a lamp and he stripped the ends off the lamp and he forgot to put the wire back right and he stuck it in the wall and went…wawawawawawa…and he went: ‘I feel better!’ So he went to the hospital and he took a couple of paddles and put it on somebody’s head and went…boom…scrambled their brains in the hope they’ll come out better this time. I don’t think ECT is really a good idea. I don’t consider it therapeutic. In fact, I don’t think the idea of locking nutty people up together is the best idea”.


  • * Pascual-Leone et al. 1993; George et al. 1996; Wassermann et al. 1996; Cohrs et al. 2001; Evers et al. 2001; Strafella et al. 2001; Padberg et al. 2002; Micheal et al. 2003, Szuba, et al., 1999