Most people think psychiatric treatment means two things: tablets and talking. There is a third option that most patients in India have never heard of, even though it has been FDA-approved for depression since 2008. It involves no medication, no anaesthesia, no surgery — and it was the subject of my DM thesis at AIIMS Delhi.
What is rTMS?
Repetitive Transcranial Magnetic Stimulation (rTMS) uses a magnetic coil placed against the scalp to deliver focused magnetic pulses to specific brain regions. Those pulses pass painlessly through the skull and induce small electrical currents in the targeted brain circuit, changing how active that circuit is.
Why does this matter? Because conditions like depression, OCD and addiction are not character problems — they are circuit problems. In depression, the dorsolateral prefrontal cortex (the brain’s executive control region) is underactive. In addiction, the circuits governing craving and impulse control are dysregulated. rTMS lets us reach into those specific circuits and gradually retune them, session by session.
Source: FDA clearance for rTMS in treatment-resistant depression, 2008; OCD, 2018; smoking cessation, 2020.
What is Theta Burst Stimulation?
Theta Burst Stimulation (TBS) is the newer, faster evolution of rTMS. Instead of a standard 37-minute session, TBS delivers stimulation in short bursts patterned on the brain’s own theta rhythm — completing a session in about 3 minutes.
The landmark THREE-D trial published in The Lancet showed that intermittent TBS was non-inferior to standard rTMS for treatment-resistant depression. Same benefit, a fraction of the chair time.
Source: Blumberger et al., THREE-D trial, The Lancet, 2018.
My own DM research at NDDTC, AIIMS Delhi focused on Theta Burst Stimulation for alcohol use disorder — investigating whether stimulating the circuits involved in craving can reduce the pull of alcohol in dependent patients. This is the frontier of addiction psychiatry: treating the reward circuit directly.
Who is it for?
rTMS and TBS are worth discussing with your psychiatrist if you have depression that has not responded adequately to two or more medication trials; OCD that persists despite treatment; addiction with intense cravings despite medication and therapy; or if you cannot tolerate medication side effects, or prefer a non-drug approach for medical reasons.
It is not a magic wand, and it is not for everyone. It is contraindicated in people with certain metal implants in the head and requires careful screening in people with seizure history. A proper psychiatric evaluation always comes first.
What a course of treatment looks like
A typical course involves daily sessions, five days a week, for four to six weeks. You sit in a chair, awake. The coil rests against your scalp. You feel a tapping sensation. You drive yourself home afterwards. The most common side effect is a mild, transient headache. There are no systemic side effects — no weight gain, no sedation, no sexual dysfunction — because nothing enters your bloodstream.
Importantly, rTMS is not a replacement for medication and psychotherapy in most cases. It works best as part of a personalised plan that may combine all three.
FAQ
Is rTMS painful? No. Most patients describe a tapping sensation on the scalp. Some experience a mild headache after early sessions, which usually settles.
Is rTMS the same as ECT (shock therapy)? No. ECT induces a controlled seizure under anaesthesia and remains a valuable treatment for severe illness. rTMS involves no seizure, no anaesthesia, and no memory side effects.
Does TBS work for addiction? Evidence is growing and promising, particularly for craving reduction in alcohol and nicotine dependence. It is best considered within a comprehensive addiction treatment plan, not as a standalone cure.