Struggling with depression that doesn’t respond to standard treatments can be disheartening. If that’s your experience, rTMS for treatment-resistant depression (TRD) could provide the relief you’ve been seeking. In this article, we’ll delve into rTMS, its success in treating TRD, and what you can realistically expect from the process.

Key Takeaways

  • Treatment-resistant depression (TRD) is a severe form of depression that persists despite using at least two different antidepressants; it significantly impacts quality of life and imposes substantial economic costs.
  • Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive intervention that has shown a notable remission rate in treating major depressive disorder, demonstrating its efficacy and safety over a typical 4-6 week daily treatment protocol.
  • Personalized care that includes tailoring treatment plans to individual needs along with maintenance therapies, like the approach used at Plus by APN, enhances long-term patient outcomes and quality of life for individuals with TRD.

Understanding Treatment-Resistant Depression

Treatment-resistant depression is a severe type of major depression that persists despite being treated with at least two different antidepressant medications. The seriousness of TRD should not be underestimated; about 30.9% of adults who receive treatment for major depressive disorder or bipolar disorder struggle with this condition in the US alone.¹

Defining Treatment-Resistant Depression

Mental health professionals diagnose treatment-resistant depression when a patient continues to experience symptoms of depression even after trying at least two different types of antidepressants or undergoing multiple treatment attempts. Doctors only diagnose this condition after utilizing standard treatments, such as medication and therapy.

The Burden of Refractory Depression

The consequences of TRD, also known as refractory depression, have a significant and widespread impact. Refractory depression has a devastating effect on one’s mental state and can lead to decreased quality of life, higher likelihood of co-occuring mental health conditions, and even suicidal thoughts.


Deep TMS vs. rTMS: What’s the Difference?

Two potential therapeutic methods have surfaced as viable treatments for TRD – deep transcranial magnetic dtimulation (deep TMS) and repetitive transcranial magnetic stimulation (rTMS). Both approaches involve noninvasive stimulation of the brain, but vary in terms of depth and FDA-approved applications.

Deep TMS Explained

Deep TMS is a distinct, noninvasive treatment approach that targets broader and deeper regions of the brain compared to traditional rTMS. This method uses magnetic technology to stimulate specific neural networks in the brain responsible for mental health, resulting in an alleviation of symptoms related to depression.

Comparing Deep TMS and rTMS

Both rTMS² and deep TMS have received FDA approval to treat major depression, and deep TMS has additional approval to treat OCD.

Deep TMS has shown promising results in treating bipolar depression, while rTMS better addresses treatment-resistant depression compared to sham treatments.

The Role of rTMS in Treating Major Depression

Research has substantiated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating major depressive disorder (MDD), particularly after two failed antidepressant treatments. 

A meta-analysis of randomized sham-controlled trials confirmed rTMS’s efficacy,⁴ showing a significant association with clinical response and remission rates in patients with treatment-resistant depression (TRD). The analysis revealed that the active rTMS group had an overall response rate of approximately 39.68%, compared to 13.71% in the sham group. 

Additionally, the remission rate was approximately 35.71% in those who received active rTMS, significantly higher than the 8.37% observed in the sham group. These findings highlight the potential of rTMS as an adjunctive treatment for MDD, providing hope for patients who have not found relief through traditional pharmacotherapy alone.

rTMS Treatment Strategy

Mental health professionals target predetermined areas of the brain with repetitive transcranial magnetic stimulation for 4-6 weeks in accordance with a standard treatment protocol. This approach can effectively alleviate symptoms associated with MDD. Unlike electroconvulsive therapy, rTMS does not require anesthesia and does not typically trigger seizures.⁵

Clinical Trials and Efficacy Data

Numerous clinical trials, specifically randomized controlled trials, show daily rTMS therapy aimed at the left prefrontal cortex can decrease symptoms of depression and promote high rates of remission.

Patient Experiences with rTMS

Patients who have received rTMS treatment have reported favorable results, including relief from depression following a period of extended treatment.

Quality of Life Improvements

RTMS has been shown to produce short-term and long-lasting improvements in patient-reported depression symptoms, resulting in a better overall quality of life. Continual rTMS treatment can also delay relapse and improve the prognosis for individuals struggling with treatment-resistant depression.

The Importance of Maintenance Treatment and Long-Term Management

Maintenance treatment is a critical component of rTMS therapy as it serves to maintain the positive outcomes achieved during the initial treatment process, reduces the risk of relapse, and improves the overall well-being of individuals with mental health disorders. This continued care helps sustain progress made in previous sessions and promotes long-term stability for patients’ mental health conditions. 

Maintenance treatments are essential to preserving and enhancing overall quality of life by preventing setbacks or worsening symptoms after rTMS clients complete a series of primary treatments.

Sustaining Results with Maintenance Sessions

Maintenance sessions play a crucial role in the success of rTMS therapy by preserving the immediate antidepressant effects and preventing relapse. These sessions also help sustain the overall improvements made to the patient’s well-being.

Long-Term Outlook for rTMS Patients

The long-term prospects for patients who receive rTMS treatment are encouraging. Studies have shown that the therapeutic benefits of rTMS in addressing major depressive disorder can be long-lasting.⁶

Begin Your Journey To Personalized Care at Plus by APN

APN’s personalized approach to TMS treatment involves thorough consideration of patient narratives, individual needs, and medical histories. From there, we carefully evaluate potential therapies using a tailored process that incorporates  all pertinent information before determining the best course of treatment for each patient.

Tailored Treatment Approaches

Plus by APN takes a personalized approach to acute treatment plans, tailoring each plan according to the specific needs and situation of every patient. This individualized method increases the likelihood of successful treatment and recovery, instead of relying on a standardized solution for all patients. Book a free consultation to get started today.

Frequently Asked Questions

Does TMS work for treatment-resistant depression?

Yes, multiple clinical trials have shown that TMS successfully alleviates treatment-resistant depression with long-lasting outcomes.

Does TMS work for persistent depressive disorder?

TMS effectively treats individuals with persistent depressive disorder who do not find relief with traditional antidepressant medications. The FDA specifically approves this therapy for cases of treatment-resistant depression.

What is Treatment-Resistant Depression (TRD)?

TRD, also known as treatment-resistant depression, is a form of major depressive disorder that continues to persist despite trying two or more different antidepressant medications. Managing this type of depression can be difficult and often requires alternative treatments due to its resistance to traditional methods.

Final Thoughts

Treatment-resistant depression is a promising option for those who have exhausted traditional antidepressant treatments. This article has provided a detailed overview of rTMS, its efficacy in treating TRD, and its comparison to deep TMS. 


Numerous clinical trials have shown that rTMS can significantly alleviate depression symptoms and improve the overall quality of life for patients with TRD. With maintenance therapy and continued care, rTMS can produce long-lasting improvements, making it a valuable option for those struggling with TRD.


Here at Plus by APN, with our personalized approach to treatment, we offer tailored treatment plans that suit each patient’s unique needs. Book a free consultation today!


  1. Zhdanava M, Pilon D, Ghelerter I, et al. The prevalence and national burden of treatment-resistant depression and major depressive disorder in the United States. J Clin Psychiatry. 2021;82(2):20m13699.
  2. Cotovio, Gonçalo et al. “Regulatory Clearance and Approval of Therapeutic Protocols of Transcranial Magnetic Stimulation for Psychiatric Disorders.” Brain sciences vol. 13,7 1029. 5 Jul. 2023, doi:10.3390/brainsci13071029
  3. “FDA Permits Marketing of Transcranial Magnetic Stimulation for Treatment of Obsessive Compulsive Disorder.” U.S. Food & Drug Administration, 17 Aug. 2018, Accessed 15 Feb. 2024. 
  4. Vida, R., Sághy, E., Bella, R. et al. Efficacy of repetitive transcranial magnetic stimulation (rTMS) adjunctive therapy for major depressive disorder (MDD) after two antidepressant treatment failures: meta-analysis of randomized sham-controlled trials. BMC Psychiatry 23, 545 (2023).
  5. Stultz, Debra J., et al. “Transcranial Magnetic Stimulation (TMS) Safety with Respect to Seizures: A Literature Review.” Neuropsychiatric Disease and Treatment, vol. 16, 2020, pp. 2989-3000, Accessed 21 Feb. 2024.

O’Reardon, John P et al. “Long-term maintenance therapy for major depressive disorder with rTMS.” The Journal of clinical psychiatry vol. 66,12 (2005): 1524-8. doi:10.4088/jcp.v66n1205