rTMS for depression: what the evidence supports, and what it does not

The short answer

Treatment-resistant depression is the indication with the largest published evidence base for rTMS, and it is the one NICE has issued interventional procedures guidance on. Outside that indication the evidence is thinner.

Where the figures are good, we will quote them with a source. Where they are not, the honest answer is that the research has not caught up yet.

Response and remission are not the same thing

This is the most common place a reader is misled, usually without anyone intending it. Response typically means symptoms have at least halved on a validated questionnaire. Remission means they have fallen below the diagnostic threshold for the condition altogether.

A halving of symptoms is a real and meaningful change. It is also not the same as being well. Someone who scores in the severe range and improves to the moderate range has responded, and still has moderate depression.

So the number matters far less than the word attached to it. A clinic quoting “60 per cent success” without saying which endpoint it means has told you almost nothing.

The timeframe is rarely attached either. A response measured at the end of a course and a response still holding a year later are different findings, and only the second one tells you anything about durability.

The figures, and who published them

Professor Alexander Sack advises this clinic. The Telegraph described him as “a global leader in neuromodulation who directs the Academy of Brain Stimulation, advises Naya Health and trains their clinicians.” Quoted in the same paper on 16 March 2026, he set out the following.

For treatment-resistant depression, meta-analyses of rTMS typically report response rates of around 50 to 60 per cent, and remission of roughly 30 to 40 per cent. He also noted that rTMS has been used clinically for more than twenty five years, which is worth holding onto when it is described as new.

First-line antidepressants, on the same account, generally show response of roughly 40 to 60 per cent and remission of about 25 to 35 per cent.

Side by side, with the caveat attached

	rTMS, treatment-resistant depression	First-line antidepressants
Response	Around 50 to 60%	Roughly 40 to 60%
Remission	Roughly 30 to 40%	About 25 to 35%
Population	People for whom antidepressants have already not worked sufficiently	People starting treatment for the first time
Source for these figures	Professor Alexander Sack, The Telegraph, 16 March 2026	Professor Alexander Sack, The Telegraph, 16 March 2026

The ranges overlap. Read the table honestly and it does not say that stimulation beats medication.

It says something more useful. The rTMS figures come from people who had already tried at least two antidepressants without sufficient improvement, which is what treatment-resistant means. Producing comparable numbers in a harder group is the interesting part, and it is not the same claim as being better.

Why trial design matters more than the headline number

The trial worth naming is Cole, E. J. et al. (2022) “Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial”, American Journal of Psychiatry, 179(2), pp. 132 to 141.

Double-blind matters because neither the patient nor the person scoring the symptoms knew who had received real stimulation. Randomised matters because it removes the clinician’s choice about who gets what. Together they are the design features that separate a treatment effect from expectation, which is why the words in a paper’s title are worth reading before its numbers.

We are not going to reproduce that paper’s outcome figures on a marketing page. It is open literature, the citation above will take you to it, and your clinician will go through what it found and what it did not.

Where the evidence is thinner

Depression is the strong case. Anxiety, chronic pain, fibromyalgia, chronic fatigue and cognitive performance are all treated with magnetic stimulation, and the published evidence in those areas is earlier, smaller and less consistent.

That does not make treatment unreasonable. It does mean the conversation has to be different, and that anyone quoting a depression-sized figure at you for a fatigue condition is quoting the wrong literature.

For ME and chronic fatigue syndrome specifically, NICE guideline NG206 sets out how the condition should be diagnosed and managed in the UK, and it is the document your clinician will work within.

What thinner evidence changes in practice is the conversation, not the technology. Your clinician should tell you which category your own condition sits in, and be specific about it. If anyone quotes a depression figure at you for a fatigue condition, ask which paper it came from.

Four questions to ask any clinic about its numbers

Sceptical? You should be. When a clinic quotes you an outcome figure, four questions will tell you whether it means anything at all.

Which endpoint is it, response or remission. In which population was it measured, and does that population include you.

Over what timeframe was the outcome assessed. And what was it compared against, if anything.

A figure that survives all four is worth discussing. A figure with no endpoint, no population and no comparator is a number rather than evidence.

We hold our own material to that standard, which is why this page quotes published literature with the source named in the sentence rather than in-house percentages.

What NICE has and has not said

NICE has published interventional procedures guidance IPG542 on repetitive transcranial magnetic stimulation for depression. That is a genuine and relevant document.

It is not an approval, because NICE does not issue approvals. It is not an endorsement of this clinic, or of any particular protocol, and you should be wary of a clinic that presents it as one.

IPG542 is worth reading for a second reason. NICE guidance describes the procedure and the evidence considered at the time it was issued, which makes it a more sober document than most clinic pages on the same subject.

Bottom line

The case for rTMS in treatment-resistant depression is real, published and quotable, and it sits at around 50 to 60 per cent response and 30 to 40 per cent remission on Professor Sack’s account in The Telegraph. Those are group figures, and roughly four people in ten do not respond at all.

Outside depression, the evidence is younger than the enthusiasm. We would rather tell you which side of that line your own condition sits on before you pay for anything.

Frequently asked questions

What is the difference between response and remission?

Response usually means symptoms have at least halved on a validated questionnaire. Remission means they have fallen below the threshold for the condition altogether. Response is the easier bar to clear, so any figure quoted for a treatment should state which of the two it refers to before you compare it with anything.

How effective is rTMS for treatment-resistant depression?

Professor Alexander Sack, quoted in The Telegraph in March 2026, said meta-analyses for treatment-resistant depression typically report response rates of around 50 to 60 per cent and remission of roughly 30 to 40 per cent. Those are pooled trial figures, not a prediction about any individual patient.

Is rTMS better than antidepressant medication?

The published figures do not support that framing. In the same Telegraph piece, Professor Sack gave first-line antidepressants a response rate of roughly 40 to 60 per cent and remission of about 25 to 35 per cent, which overlaps the rTMS range. The populations studied are also different.

Has NICE approved rTMS for depression?

NICE issues guidance rather than approvals, so approved is the wrong word. NICE has published interventional procedures guidance IPG542 on repetitive transcranial magnetic stimulation for depression. That is a real and relevant document, and it is not the same thing as an endorsement of any particular clinic or protocol.