Treatment-Resistant Depression Treatment in Marylebone, London

Treatment-resistant depression means your depression has not improved enough after at least two different antidepressants, each taken at an adequate dose for an adequate length of time. A medication stopped after a fortnight because of side effects is not a failed trial. It is a clinical category, not a verdict on you.

Reaching that point does not mean nothing works. It can mean the mechanism the medication acts on is not the main one driving your symptoms. Antidepressants change chemical signalling across the whole brain. Magnetic stimulation does something narrower: it changes activity in one targeted circuit, repeatedly, until the pattern shifts.

The circuit in question is the left dorsolateral prefrontal cortex and its connections to the anterior cingulate cortex and the limbic structures below it. In depression that prefrontal region is typically underactive while the limbic structures are overactive. Stimulating the prefrontal target is intended to restore the balance between the two.

This is the indication with the largest published evidence base for rTMS. Several sham-controlled trials support it, and NICE has issued interventional procedures guidance, IPG542. Professor Alexander Sack, quoted in The Telegraph on 16 March 2026, said meta-analyses in treatment-resistant depression typically report response of around 50 to 60 per cent and remission of roughly 30 to 40 per cent, against roughly 40 to 60 per cent response and 25 to 35 per cent remission for first-line antidepressants. Those ranges overlap, and that is the honest way to read them. Stimulation is a serious option once medication has not worked. It is not a replacement for everything that came before it.

Newer research has focused on making the target more precise and the course shorter. Cole, E. J. et al. (2022) "Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial", American Journal of Psychiatry, 179(2), pp. 132–141, tested an individually targeted accelerated protocol against a sham. Individual targeting is the principle we work to here. Your motor threshold sets your dose, and candidate sites are tested rather than assumed.

Not everyone responds. Relapse happens, and a second course is a normal part of the picture rather than a sign of failure. Because the same measures are repeated partway through a course, you find out early whether your own numbers are moving. If they are not, we will tell you and stop.