rTMS stands for repetitive transcranial magnetic stimulation. The word repetitive distinguishes treatment from the single magnetic pulses used in neurology research. In rTMS, pulses are delivered in trains, many times per second, over a set number of minutes, and the pattern is repeated daily across several weeks. Delivered at high frequency, around 10 Hz, these trains tend to increase activity in the targeted area. Delivered at low frequency, around 1 Hz, they tend to reduce it. For depression, high-frequency stimulation of the left dorsolateral prefrontal cortex is the most studied protocol.
The first rTMS device was FDA-cleared for depression in 2008 after controlled trials showed better results than sham treatment in patients who had not improved on antidepressants. Since then, protocols have shortened and devices have multiplied, including Deep TMS with its H-coil and theta burst protocols that compress a session into a few minutes. In everyday use, people often say TMS and rTMS to mean the same thing, and both describe what you would receive in a clinic. A full course is usually 36 sessions over six to nine weeks, with maintenance sessions available later if symptoms begin to return. You remain fully awake, need no sedation, and can drive afterward. Stedfast Psychiatry offers the Deep TMS version of rTMS at our Palm Beach Gardens office.