Does transcranial magnetic stimulation work?

The comment I mentioned in the last post also asked how repetitive transcranial magnetic stimulation (rTMS) works and whether it is similar to ECT. The comment was made following my mention of rTMS in a previous blog entry in response to the NIMH medical director's blog. The NIMH website itself has a page on brain stimulation therapies, and both ECT and rTMS are in the list.

I've never seen rTMS (although I have seen ECT). My understanding is that an electromagnet is placed over the skull and the patient usually wears earplugs to diminish the noise from the discharging coil. Rhythmic pulses of electromagnetism are delivered usually in daily sessions lasting about 30 minutes for 2-4 weeks and possibly longer. The patient may experience involuntary spasms of scalp muscles.

NICE says there is uncertainty about the procedure's clinical efficacy for depression (see guidance). Despite this, it is available in Canada, for example, and the costs at a MindCare Centre are CAN$250 per treatment, amounting to CAN$5000 to CAN$7500 for a course of treatment. So it's not cheap and I'm not sure if insurance pay out easily on a case-by-case basis.

Even despite the cost, in many ways development of the procedure has been slow but of course there's no drug company behind it. And I'm not sure about its acceptablity. Maybe it makes psychiatry's quackery too transparent. Psychiatry has always been wishful in its thinking about physical treatments (eg. see previous post about deep brain stimulation).