Applications and Effectiveness of rTMS in the Treatment of Psychological Disorders

rTMS in Psychological Treatment The use of rTMS in the treatment of psychological disorders has attracted a great deal of attention over the past several years. Many describe it as a modern miracle and a cure-all, while some are skeptical about its actual effectiveness! In reality, the applications and effectiveness of TMS and rTMS cannot be summarized so simply.

In this Blogpost, by reviewing research related to the applications and effectiveness of this tool, we attempt to provide precise and comprehensive answers to these questions.

What Is rTMS?

rTMS, Repetitive Transcranial Magnetic Stimulation, is a non-invasive neuromodulation method. Although it has been studied by specialists and researchers for a long time, as a tool that is broadly accessible, it is considered one of the newer and more recent tools.

Its non-invasive nature means that using this method requires no surgery, anesthesia, or special care. Likewise, based on extensive and long-term studies, we know that it does not have serious or long-term side effects.

To use the device, a powerful coil through which a strong electric current passes is placed near the individual's skull. Electromagnetic waves are generated as a result of the electrical current passing through the coil, and these waves affect brain neurons. The goal is to alter the activity of neural networks involved in various important activities and skills.

Treatment with rTMS (for different conditions) generally requires multiple sessions over several consecutive weeks.

Applications and Effectiveness of rTMS in Rehabilitation

The primary and original application of rTMS is in rehabilitation. Neural pathways or neural structures damaged for various reasons (for example, stroke or TBI) naturally have the ability to repair themselves and generate new pathways; however, with increasing age (given that strokes occur more frequently among older adults), this capacity for repair and regeneration becomes slower. Transcranial magnetic stimulation can artificially create, within a much shorter period, the stimulus that neurons and neural structures naturally generate over a very long period under these circumstances. As a result, alongside various activities that are effective and helpful in rehabilitation, rTMS can accelerate the natural process.

Proper and effective use of rTMS in rehabilitation requires consideration of numerous complex factors. If needed, you can review them in Lefaucheur et al. (2020). (Lefaucheur, Aleman, Baeken, et.al., 2020)

The effectiveness and benefits of rTMS in rehabilitation have been examined and reported in numerous studies over the past decade. At present, the largest body of evidence for the effectiveness of rTMS concerns the recovery of motor functional abilities (in the upper and lower limbs). Other evidence indicates that rTMS is effective in recovering speech and swallowing abilities after stroke.

For example, one promising study showed that approximately 65 percent of individuals who had lost their ability to speak following a stroke regained this ability after 20 minutes of brain magnetic stimulation for 10 consecutive days. (Ren, Zhang, et.al, 2014)

Likewise, swallowing difficulties, which are common after stroke, can be recovered with the help of rTMS in a much shorter period of time. (Yang, Cao, et.al, 2021)

The evidence concerning the recovery of lost cognitive skills after stroke is also highly promising. rTMS had a significant and substantial effect on the recovery of skills such as (maintaining) attention, (understanding) language, memory, and visuospatial functioning. (Zhao, Meng, et.al, 2024)

However, relying on this evidence requires further and more precise studies in this area.

Side Effects of Using rTMS

As mentioned, rTMS is generally considered very safe, with far fewer side effects reported compared with similar methods. For example, based on current statistics and after appropriate precautions are followed, the probability of a seizure is one in thirty thousand. Other side effects, such as temporary dizziness and headaches (possibly due to the device's loud sounds), have also been reported. These remain rare, are transient and temporary when they occur, and are considered negligible compared with the benefits of this method. (Taylor, Newberger, et.al, 2021)

rTMS in the Treatment of Psychological Disorders

Based on the findings we have reviewed so far, rTMS is a highly useful tool with very few and negligible risks. However, it is important to consider that this evidence concerns the improvement and reconstruction of neural pathways in people who experienced brain damage due to stroke. Building on this evidence and considering its very few and negligible side effects, many specialists became interested in the application and effectiveness of rTMS in the treatment of psychological disorders.

Initial evidence also suggested that it was effective; however, this is not the complete picture, and at present, this evidence cannot be considered reliable. We will examine these issues below.

The Use of rTMS in Treating Depression Caused by TBI

TBI, Traumatic Brain Injury, can in addition to various problems and challenges depending on the area of the brain that was injured, sometimes lead to depression. In different cases, the reason for the emergence of depression may vary, but generally it can be divided into two categories: cognitive and structural.

In some cases, an individual who has sustained a serious brain injury in a car accident, while playing sports, or completely by accident may lose a significant portion of their motor and/or cognitive abilities. This itself can act, at the cognitive level, as a major stressor capable of triggering depression. On the other hand, damage to brain structures and connections can lead to depression by altering various neural pathways and neurotransmission processes.

In the real world, cases cannot be neatly divided into one of these two categories; generally, we observe that the negative impact of the stressor is intensified by structural and functional changes in the brain. Ultimately, because the individual faces numerous problems and challenges, the emergence of depression receives less clinical attention.

The use of rTMS to treat depression caused by TBI was one of the first applications proposed by specialists for the treatment of psychological disorders. Initial studies indicated substantial effects and success, which led to greater attention toward the application of rTMS in psychology and psychiatry. However, subsequent longitudinal studies that examined these cases and the effectiveness of this method over the long term showed that this positive effect was very short-term and temporary.

In most cases, the benefit of rTMS had completely disappeared after only one month. Combining rTMS with cognitive exercises and focusing on functional outcomes (such as attention and memory) was capable of extending the period of effectiveness; however, its effect still had a limited duration. (Tsai, Chen, et.al, 2021)

One assumption we can consider regarding the reason for this may be based on distinguishing the factors that cause depression in these cases. rTMS may be capable of helping with relevant neural structures and connections; however, the cognitive dimensions of depression also require independent clinical attention.

This explanation is one of the reasons many people question its effectiveness in psychological disorders despite positive results in studies. In the following sections, we will examine this evidence separately for different psychological disorders.

Evidence for the Effectiveness of rTMS in Treating Psychological Disorders

The largest and strongest body of evidence currently available for the effectiveness of rTMS in treating psychological disorders concerns TRD, Treatment-Resistant Depression.

Treatment-resistant depression is a term used to refer to cases in which, despite receiving first- and second-line treatments, no signs of improvement are observed. These cases are very rare, and generally, upon closer examination, a biological or neurological reason for the lack of effectiveness of first- and second-line treatments is identified. One assumption was that at least some of these reasons might be related to neural structures and connections; consequently, the use of rTMS was proposed and implemented.

Before examining the evidence, it is important to examine the concept of treatment-resistant depression. In psychiatry, the term TRD is used when two complete courses of pharmacological treatment (from two different medication classes) fail to produce any positive effect in the individual. After psychotherapy and two complete courses of pharmacological treatment (from two different medication classes) have failed, specialists (generally psychiatrists) are permitted to formulate an individualized treatment plan for the client and use alternative methods of treating depression (for which there is usually no standardized and universal protocol), such as rTMS.

An important point is that under these circumstances, rTMS is generally used alongside other alternative methods, and particularly because of its very high cost, it is accessible only to individuals with greater financial resources. This is one of the reasons for the low generalizability of many related studies; that is, even if sufficient and long-term effectiveness is reported in a case, it is very difficult to distinguish the various factors that contributed to improvement. At the same time, because no official protocol has been developed for its use in treating psychological disorders, specialists use different devices with different characteristics, as well as different targets.

Despite these considerations and the difficulty of generalizing the findings, there is a larger problem in confirming its effectiveness in TRD: at present, research findings are highly heterogeneous. This means that in some cases appropriate effectiveness is reported, while in others no effectiveness is observed (Jones, Weissman, et.al, 2021).

Studies that attempt to account for the placebo effect as a variable do not find a significant difference between the benefit of placebo and the actual benefit of rTMS for TRD. (Jones, Weissman, et.al, 2021; Kennedy, 2024) For example, in one study, researchers actually used the device for one group of participants, while for another group they merely turned the device on without actually administering the stimulation (sham rTMS). In this study, some individuals who received no magnetic stimulation at all reported greater improvement than some individuals who actually received magnetic stimulation.

Ultimately, participants who reported improvement, regardless of whether they had actually received magnetic stimulation, reported a return of symptoms over relatively short periods of time. (Reddy, Rains, et.al, 2026) Note that this does not mean that rTMS is not useful; rTMS is highly effective and useful in rehabilitation, and in fact, that was what it was originally designed and developed for. However, for various reasons, current evidence indicates that rTMS no longer provides a benefit for TRD (and many psychological disorders); or, if a benefit is reported, it is generally a placebo effect and disappears after some time.

Effectiveness of rTMS in Other Psychological Disorders

The use of rTMS in the treatment of other psychological disorders has also been proposed. OCD (Obsessive-Compulsive Disorder), GAD (Generalized Anxiety Disorder), and PTSD (Post-Traumatic Stress Disorder) are among the disorders for which sufficient evidence is available.

For example, a meta-analysis of the use of rTMS in OCD shows that its use increases the likelihood of symptom reduction; however, it does not have a significant effect on remission (complete recovery). (Rehn, Eslick & Brakoulias, 2018)

Evidence concerning its use for GAD, despite promising findings, has major sampling challenges that currently make it impossible to draw conclusions from the evidence. (Parikh, Strawn, et.al, 2022)

Its use in the treatment of PTSD had shown effectiveness in a very small number of cases; however, more recent evidence indicates high effectiveness alongside appropriate durability, which is noteworthy. (Xu, et.al. 2024)

Evidence for its application in other psychological disorders is even weaker and less reliable.

Why Is rTMS (Currently) Not Effective in Treating Psychological Disorders?

The answer to this question is highly complex and difficult; more importantly, with the current evidence and information, it is not possible to answer it at all. However, generally speaking, two main hypotheses can be considered: As we mentioned regarding depression caused by TBI, psychological disorders are not located only in the brain!

A wide variety of factors act together to affect us, none of which can be ignored. Even if we could completely and precisely use rTMS to resolve the brain-related problems associated with psychological disorders, there would still be many diverse issues that would need to be “treated.” However, this point does not mean that rTMS is useless in the treatment of psychological disorders. The second and more important hypothesis we can consider regarding its current lack of effectiveness is that, due to substantial limitations in clinical samples, along with differences between various rTMS devices, we have not yet been able to identify the correct and optimal way to use it for psychological disorders.

The day we discover this precise and optimal method, rTMS could have an important place and a major role in the treatment of psychological disorders. Until that day arrives, we should be skeptical of those who make unrealistic claims about its applications.

Conclusion; Reviewing the Applications and Effectiveness of rTMS in the Treatment of Psychological Disorders

By now, you have probably encountered advertisements; a billboard in the city, tele marketers, or Instagram pages making claims that present rTMS as a miracle! “Treatment in one session” or “definitive cure,” and claims that are not only unrealistic and unscientific but, given the high cost of these sessions, can create many challenges.

As mentioned, there is currently no official protocol for the use of rTMS in psychological treatments, and specialists are permitted to prescribe it only as a last-line treatment, when two complete courses of pharmacological treatment and psychotherapy have failed to show any positive effectiveness. At the same time, we need more data and information in order to develop a precise and optimal protocol.

Considering that this method does not have any particular risks or side effects, and that we know it can provide many benefits, using it when the necessary conditions and access are available not only does not have any particular harm and may provide benefits, but can also contribute substantially to the advancement of science on the tool. The only point we need to keep in mind is not to become caught up in the unrealistic, unscientific, and exaggerated claims associated with it.