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What are rTMS and iTBS?

Learn what rTMS and iTBS are, their main differences, and how these approved non-invasive neuromodulation treatments are applied in practice without anaesthesia.

Repetitive Transcranial Magnetic Stimulation (rTMS) is an FDA-approved, non-invasive medical treatment that uses powerful magnetic fields to selectively stimulate nerve cells in the brain. iTBS (intermittent theta burst stimulation) is its technological evolution, a protocol that delivers similarly strong therapeutic effects in only 3 minutes.

Both methods are performed in the clinic while the patient is fully awake, without the need for anaesthesia, systemic pharmacotherapy, or hospitalization. They offer a highly safe alternative for treatment-resistant depression and obsessive-compulsive disorder (OCD).

Brief definition of rTMS

rTMS works according to the principles of physics and electromagnetism. A specialized coil is placed on the patient’s scalp. This coil generates an instantaneous and powerful changing magnetic field, similar to that used in magnetic resonance imaging, approximately 1.5–2.5 Tesla.

The magnetic field passes through the skull without obstruction and induces a very small electrical current in the neurons of the underlying cortex. By repeating these pulses, the psychiatrist can directly influence — either increasing or decreasing — the excitability of specific brain regions, such as the dorsolateral prefrontal cortex. In this way, neuroplasticity is activated and the normal function of neural networks involved in depression is restored.

What is the difference between rTMS and iTBS?

The main difference lies in treatment time and pulse pattern:

  • Classic rTMS (10 Hz): Delivers magnetic pulses at a fixed frequency of 10 pulses per second. A classic depression-treatment session usually lasts from 19 to almost 40 minutes.
  • iTBS (theta burst): Instead of fixed pulses, it delivers “bursts” of pulses in a specific rhythm — theta rhythm, 5 Hz — which mimics the brain’s natural communication frequency, the hippocampal theta rhythm. Because of this biological “compatibility,” iTBS achieves the same enhancement of neuroplasticity in only 3 minutes.

Both protocols have comparable effectiveness, as shown in the large THREE-D clinical trial in 2018, but iTBS is significantly more patient-friendly because it minimizes the time spent in the treatment chair.

How a session is performed in practice

The procedure is designed to cause the least possible disruption to your daily routine:

  1. No preparation is required: You can eat and drink normally before coming to the centre.
  2. Comfort during the session: You sit in a special, comfortable chair, similar to a dental chair, while fully awake.
  3. Application: The physician precisely identifies the target area on your head. During pulse delivery, you will hear an intermittent sound, similar to the clicking of an MRI scanner, and feel a light “tapping” sensation on the scalp. It does not cause pain, although there may be temporary discomfort during the first sessions.
  4. Immediate return to activities: Once the 3-minute iTBS session, or the corresponding protocol, is completed, you can stand up, drive, and return to work immediately. There is no effect on your mental clarity.

Who may be a candidate for treatment?

Treatment, whether classic rTMS or iTBS, is mainly indicated for:

  • Patients with treatment-resistant depression (TRD), meaning they have already tried at least two different antidepressant medications without satisfactory benefit.
  • Patients who cannot tolerate medication side effects, such as gastrointestinal symptoms, weight gain, or sexual dysfunction.
  • Patients with obsessive-compulsive disorder (OCD) who show resistance to pharmacotherapy.
  • Situations where medication use carries risks, such as pregnancy.

Who cannot receive rTMS: people with non-removable metallic objects in the head or neck, such as cochlear implants or aneurysm clips, or those with an active medical history of epilepsy or seizures.

Next steps

If you believe rTMS may be the next step in your treatment, learn more through our detailed guide:

rTMS guide

Core concepts

Treatment indications

How it works

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