Transcranial magnetic stimulation (rTMS, deep TMS, theta-burst, SAINT)

Domain IX · Biomedical, neuro & digital · 2008 · USA

What it is

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation treatment that a psychotherapist does not deliver. NICE describes it as an outpatient procedure that needs no anaesthesia: a purpose-made electromagnetic coil is held against the scalp and induces small electric currents in…

Format

• Obsessive-compulsive disorder, adults: BrainsWay deep TMS authorised via the De Novo pathway, FDA press release 17 August 2018, for people who have not responded to traditional treatments; BrainsWay describes the OCD indication as adjunctive. NeuroStar also lists an adjunctive adult OCD indication…
• Anxious depression (comorbid anxiety symptoms in adults with MDD): BrainsWay clearance announced 18 August 2021; NeuroStar also lists reduction of comorbid anxiety symptoms in adult MDD.

Who practises it, and how they are trained or regulated

• USA (FDA, as of October 2026). TMS devices are prescription medical devices. NeuroStar states it is available only on prescription by a licensed physician; the physician decides whether it is indicated, determines the treatment plan and remains medically responsible, and may delegate daily sessions to properly trained staff. Clearances per indication and age, as sources state them: Major depressive disorder, adults,…
• Australia and New Zealand (RANZCP 2024). A psychiatrist must screen, select and prescribe; psychiatrists must be credentialed by their institution (manufacturer training alone is insufficient); trainees and other clinicians such as psychiatric nurses may administer only under a credentialed psychiatrist's supervision. Devices must be TGA-approved (Medsafe in New Zealand); rTMS for depression is funded on the…
• Operator training internationally: the IFCN guidelines summarise minimum training requirements for TMS operators.

Evidence status, as the guide reports it

• England and Wales (NICE). IPG542 (16 December 2015, replacing IPG242): rTMS for depression shows no major safety concerns and adequate short-term efficacy though clinical response is variable; it may be used with normal arrangements for clinical governance and audit; clinicians should tell patients…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• silent dropout; ask about attendance every session.
• pinning all hope on TMS; keep other supports active.
• financial exploitation and loss of trust in mainstream care.
• overloading the client during the course; keep homework light and specific.
• avoidance and anticipatory anxiety in the first week; a practical plan usually helps.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.