The Differences Between rTMS and dTMS

By: Jayson Tripp, MD


Transcranial Magnetic Stimulation (TMS) is a noninvasive, drug-free treatment option for depression, OCD, and other mental health conditions. TMS uses a magnetic coil, similar to an MRI magnet, that sends pulses of energy to stimulate specific areas of the brain that are associated with mood. A typical course of TMS consists of five treatments per week for six to eight weeks, or 30–40 treatment sessions.

TMS has little side effects. The most common side effect, reported by about 50% of patients, is a mild headache during and immediately following treatment for a short time. These headaches reportedly go away within the first couple of weeks of treatment. Other side effects include facial twitching and tingling scalp. A very rare side effect is seizures, which have occurred in 0.1% percent of patients during clinical trials. Some studies reported zero seizures.

There are two types of TMS that are approved by the FDA: repetitive transcranial magnetic stimulation (rTMS) and deep transcranial magnetic stimulation (dTMS). Both treatments have been proven to provide significant, long-lasting improvements in depression symptoms. However, the two types of TMS also have some differences.

What Is rTMS?

Repetitive transcranial magnetic stimulation, or rTMS, has been in use since 1985 and was FDA approved as a treatment for major depressive disorder in 2008. rTMS uses a magnetic coil, shaped like a figure 8, which can penetrate about three centimeters below the skull, allowing it to stimulate the prefrontal cortex.

Studies show that after six weeks (30 sessions) of treatment, the response rate of rTMS is about 58% and the percentage of patients who receive remission is about 37%.

What Is dTMS?

Deep transcranial magnetic stimulation, deep TMS, or dTMS is a type of TMS developed by BrainsWay. It uses a different magnetic coil than rTMS known as the H-1 coil. This coil was developed by BrainsWay in 2000 and approved by the FDA as a treatment for major depression in 2013.

The H1 coil can penetrate four centimeters below the skull, which allows it to stimulate more areas of the brain than rTMS. Studies on deep TMS (Brainsway D for depression) show that after four weeks (20 sessions), 64% of patients responded positively to the treatment and 42% achieved remission. And after six weeks (30 sessions), those rates increased to 75% of patients responding to treatment and 51% achieving remission.

In 2018, the FDA approved another coil developed by BrainsWay known as the H-7 coil, which can penetrate even deeper into the brain, relieving the symptoms of obsessive-compulsive disorder (OCD). BrainsWay reports that dTMS with the H-7 coil provided more than a 30% reduction in symptoms for 38.1% of OCD patients and more than a 20% reduction in symptoms for 54.7% of OCD patients.

What’s the Difference Between rTMS and dTMS?

Both rTMS and dTMS are safe, noninvasive treatments and are not known to have any differing side effects. The main difference between rTMS and dTMS is the coils that are used in the machine. rTMS uses a figure 8 coil that can penetrate three centimeters below the skull, focusing on the prefrontal cortex. However, depression affects more than just the prefrontal cortex.

To treat depression, dTMS uses either the H-1 coil, which can penetrate much deeper and reach broader areas of the brain that are affected by depression. Studies also show that dTMS has a higher response and remission rate than rTMS. dTMS is also approved by the FDA to treat OCD using the H-7 coil; rTMS is only approved to treat Major Depressive Disorder.

Serenity Mental Health Centers uses BrainsWay’s Deep TMS system because of its superior response rate, its ability to penetrate deeper and broader areas of the brain, as well as its safety record and minimal side effects. To learn more and find out if you qualify for deep TMS as a treatment option for your mental health condition, contact us to schedule an appointment with a psychiatrist.

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*All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.