rTMS: an option against medication-resistant depression
Living with depression that resists treatment is a profoundly exhausting experience, both for the person affected and for those around them. Thousands of Quebecers consult, try one antidepressant, then another, without ever regaining lasting well-being. Between 2018 and 2022, the use of antidepressants continued to increase in Quebec, a sign that the demand for relief […]
Living with depression that resists treatment is a profoundly exhausting experience, both for the person affected and for those around them. Thousands of Quebecers consult, try one antidepressant, then another, without ever regaining lasting well-being. Between 2018 and 2022, the use of antidepressants continued to increase in Quebec, a sign that the demand for relief often exceeds the results achieved by first-line treatments.
A Canadian study conducted in primary care with more than 1,200 patients suffering from major depression also found that about 22% of them met the criteria for treatment-resistant depression, that is,the failure of at least two antidepressants of different classes, taken at an adequate dose and for a sufficient duration. For caregivers, this reality is often lived in silence: helplessness in the face of the ineffectiveness of the treatments tried, exhaustion from supporting someone without seeing improvement, and uncertainty about the next steps to consider.
For these people, and for loved ones looking for answers alongside them, one option now stands out with renewed institutional support: repetitive transcranial magnetic stimulation, or rTMS. This is not an experimental or marginal treatment: in January 2026, the National Institute of Excellence in Health and Social Services (INESSS) officially ruled on its clinical effectiveness and its place in the care pathway in Quebec, a step that gives rTMS a level of institutional credibility rarely so clearly granted to an approach still little known to the general public.
What is rTMS? A non-invasive approach for the brain
rTMS is a non-invasive neuromodulation technique that targets specific areas of the brain using electromagnetic pulses, without anesthesia (INESSS, January 2026):
- concretely, a coil is positioned above the dorsolateral prefrontal cortex, a region of the brain whose activity is often reduced in people living with depression,
- the magnetic pulses pass through the skull to stimulate neurons and encourage communication between them, gradually helping restore connections that have weakened over time,
- a session generally lasts between 20 and 40 minutes,
- the patient remains seated and awake, without sedation or surgery, and can resume usual activities immediately afterward, including driving or returning to work.
There are now more advanced variants of this technology, including deep TMS, an approach offered by Neuroperforma that makes it possible to reach deeper brain structures.
Who is rTMS for?
rTMS is indicated for adults with refractory depression, meaning depression that has not responded to at least two different antidepressant treatments (INESSS, January 2026). It can apply to both unipolar and bipolar depressive disorders, depending on the psychiatrist's assessment. rTMS is approved by Health Canada since 2002 for mental disorders resistant to first-line treatments, and it is now offered throughout Quebec in this specific context.
At Neuroperforma, each TMS protocol is prescribed and supervised by a psychiatrist who is a member of the Collège des médecins du Québec (CMQ), who determines patient eligibility following an individual psychiatric assessment. This step also makes it possible to rule out contraindications and answer questions from the patient and their loved ones before the protocol begins. For caregivers accompanying a person in this process, knowing that each step is framed by a rigorous medical assessment can in itself bring some relief: the decision rests on an individualized clinical judgment.
What INESSS says: official validation for Quebec
In its January 2026 report, INESSS concludes that rTMS is clinically effective : about one third of treated patients show a significant reduction in their depressive symptoms. This Quebec recognition aligns with broader Canadian clinical guidelines. The Canadian Network for Mood and Anxiety Treatments (CANMAT 2023) also recognizes rTMS as a high-level evidence-based option for treatment-resistant depression, although results vary from one person to another.
The Institute also recommends that rTMS be considered before electroconvulsive therapy (ECT), because of its more favorable safety profile. In all cases, the choice is made through a shared decision-making process between the patient and their psychiatrist, taking into account:
- medical history,
- symptom severity,
- and personal preferences.
A safe and well-tolerated approach
Fear of side effects is often an important barrier to treatment, particularly for people who mistakenly associate rTMS with electroshock therapy. According to INESSS, the reported effects are generally mild and temporary: headaches or slight scalp sensitivity at the stimulation site, which usually subside over the course of the sessions. More serious effects, such as seizures, remain extremely rare, provided that a preliminary medical assessment is performed, a step that is an integral part of the evaluation process before any protocol.
Unlike ECT, rTMS does not cause memory problems or risks associated with general anesthesia, which partly explains why experts increasingly consider it a step to prioritize before considering more invasive approaches for treatment-resistant depression. For many patients, knowing that they remain awake, autonomous, and able to resume their activities as soon as the session ends changes their perception of the treatment in a concrete way and eases some of the anxiety that often accompanies the decision to undergo it.
Access and coverage in Quebec
Quebec is one of the few Canadian provinces to offer this approach free of charge in the public system : rTMS is covered by RAMQ since 2013. The 17 devices currently in use are nevertheless concentrated in only seven health regions, creating significant access inequalities depending on place of residence, a reality that INESSS highlights by recommending additional equipment across the territory.
Between 2013 and 2022, the number of sessions covered by RAMQ was multiplied by 13, a sign of growing adoption but still insufficient in the face of demand. Wait times in the public system vary considerably from one region to another, ranging from one week to six months.
For people who want a faster assessment or are looking for an individualized protocol, private clinics such as Neuroperforma offer deep TMS, with complete clinical support and generally shorter wait times. As in the public system, each process begins with a complete psychiatric assessment, carried out by a psychiatrist who is a member of the CMQ, who determines whether TMS is appropriate for the patient's specific situation. Interested individuals can also explore neurofeedback, a complementary approach offered by Neuroperforma for other clinical profiles.
In conclusion
INESSS recognition of rTMS marks a turning point for people living with depression resistant to antidepressants, and for their loved ones who have often been looking for a not-yet-tried option for a long time. Whether you are experiencing this reality yourself or supporting a loved one who identifies with it, it is normal to feel both hope and some caution toward an approach that is still little known. Results vary from one person to another, and an individual assessment is always necessary before starting a protocol.
If you or a loved one recognize yourselves in this journey, the first step is to speak with a doctor or psychiatrist to explore the available options, including transcranial magnetic stimulation offered by Neuroperforma.
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