Health Sciences North's Mental Health and Addictions Program expanded its neurostimulation services in 2026 with the introduction of repetitive Transcranial Magnetic Stimulation (rTMS). rTMS is a non-invasive, evidence-based outpatient treatment for adults living with treatment-resistant depression whose symptoms have not improved despite appropriate trials of antidepressant medications and other standard treatments. Treatment-resistant depression means depression that has not improved after trying several antidepressant medications at the right dose and for the right amount of time. If rTMS may be appropriate for your care, your psychiatrist and/or primary care provider can discuss this treatment option and refer you for assessment. A psychiatrist trained in rTMS will determine whether you are eligible and oversee your care throughout treatment.
What is rTMS Treatment Like?
rTMS treatments are done on an outpatient basis. Sessions are scheduled five days a week, Monday through Friday, for about six weeks. Most people have at least 30 sessions. Each session lasts about 15 to 30 minutes, and you can go back to your usual activities right after.
How does rTMS work?
rTMS uses a device that sends gentle magnetic pulses to parts of the brain that help control mood. During the treatment, a small coil is placed on your scalp to deliver these pulses, which safely pass through your skull and activate brain cells linked to mood. Over time, this can help these brain networks work better. You will be awake and alert during the treatment sessions.
How effective is rTMS?
rTMS can be an effective option for people with depression where symptoms have not improved with other treatments. The Centre for Addiction and Mental Health (CAMH) reports that about 50% of people who receive repetitive Transcranial Magnetic Stimulation (rTMS) see a big improvement in their symptoms, and around 30% have their symptoms go away.
Source: Centre for Addiction and Mental Health. Ontario Repetitive Transcranial Magnetic Stimulation (rTMS) Program.
How safe is rTMS and what are the possible side effects?
rTMS is a safe and well-tolerated treatment for most people. The most common side effects are temporary and may include mild headache, scalp discomfort, facial muscle twitching, or feeling light-headed during or shortly after treatment. These side effects are generally mild and often improve as treatment continues. Serious side effects, such as seizures, are very rare. If you experience a headache after treatment, you may take acetaminophen (Tylenol®) or ibuprofen (Motrin®) as directed by your healthcare provider. If you develop a severe headache that does not improve with medication, or if you have any concerning symptoms, contact your healthcare provider or seek medical attention.
How do I prepare?
Before your first treatment, you can ask any questions you have during your initial assessment and education sessions. Your care team will go over what to expect and answer any other questions before you start. Please wear comfortable clothes without metal, like zippers or snaps, and follow any instructions about your medications.
Electroconvulsive Therapy, or ECT, is a procedure used to treat severe depression and other mental illnesses. You may require this procedure as part of your care and treatment plan if your psychiatrist recommends it.
What is ECT treatment like?
ECT involves passing a small, controlled, electric current between two metal discs (electrodes) which are applied on the surface of the scalp. The two electrodes may be placed on one side of the head for unilateral ECT, or on both sides of the head for bilateral ECT. The electric current passes between the two electrodes and through part of the brain in order to stimulate the brain; that electrical stimulation induces a convulsion or seizure, which usually lasts from 20 to 90 seconds.
How does ECT work?
It is not totally understood how ECT relieves symptoms, as is the case with many medical treatments. It is believed that ECT affects some of the chemicals that transfer impulses or messages between nerve cells in the brain more strongly and quickly than some medications. The treatment may correct some of the biochemical changes that accompany the illness.
How effective is ECT?
Studies comparing the effectiveness of ECT and drug therapy in depression have consistently shown that ECT is the more effective treatment of depression, especially in patients whose illness does not respond adequately to drug treatment.
The total number of treatments required to get the full benefit from ECT may range from 6 to 20, depending on the patient’s diagnosis and response to treatment. In some patients, a response may be evident after 3 treatments; however, a full course is generally recommended to obtain a full response. Some patients require periodic or maintenance treatments to sustain their improvement.
How safe is ECT and what are the possible side effects?
ECT is considered a safe procedure. It has been demonstrated to be safe when given to elderly patients, as well as during pregnancy, with proper monitoring. Some side effects may occur including nausea, headaches, or fatigue. Your healthcare team can provide you with education and answer any questions or concerns you may have before starting treatment.
How do I prepare?
Patients are prepared for ECT in the same way that surgical patients are prepared for any procedure that needs an anaesthetic.
- Be sure you understand the consent and information that has been provided by your doctor or nurse. Ask them to explain anything about the treatment that you do not understand.
- Bathe or shower and wash your hair the night before or in the morning.
- Leave valuables (watch, jewelry, wallet, etc.) at home, if you are coming from home.
- Do not eat or drink after midnight the night before each treatment. Brushing your teeth and using mouthwash is fine.
- Remove nail polish and make-up, contact lenses and dentures.
- If you are an out-patient, please report to the hospital at 6:30am.
- Empty your bladder before treatment.
- An ECT nurse will be at the hospital to provide guidance from beginning to end
Medication usually taken in the morning should be taken after treatment. However, essential medication (e.g. for high blood pressure) that your physician has advised you take, may be taken with a sip of water. In addition, your physician may request that you not take certain medications the night before treatment.
What to expect after ECT treatment? Discharge Information
- If you are an out-patient, have someone drive you to the hospital as you will not be allowed to drive or take the bus following treatment. Do not drive for at least 24 hours following the treatment.
- Acetaminophen (Tylenol) or Ibuprofen (Motrin) may be taken as prescribed every 4 to 6 hours if you have a headache. If you have a severe headache that does not respond to medication, call your doctor or visit a medical clinic.
- Acetaminophen (Tylenol) or Ibuprofen (Motrin) may be taken as prescribed for muscle stiffness. A warm bath is also helpful.
- Be prepared to rest during the day.
- You may be discharged no earlier than 9:30 to 10:00 am.
- Smoking is not allowed until 12:00 noon the day of treatment.
- Because you may have some confusion or memory loss, do not make important personal or business decisions for 24 hours.
- Do not drink alcohol for 24 hours.
Please take the time to watch the Electroconvulsive Therapy (ECT) video.
rTMS Eligibility Criteria:
rTMS is a non-invasive, evidence-based outpatient treatment for adults living with treatment-resistant depression who have trialed psychotherapy and/or medication treatment and have not seen a reduction in symptoms. When making your referral, please specify which treatment options were trialed and for how long.
Referrals
E-referrals
Electronic referrals (e-referrals) are now available using Ocean Health Map.
HSN Adult Psychiatric Outpatient Clinic - ADULT
Fax referrals
Service providers can fax referrals to 705-688-7770.
Access a copy of the Adult Psychiatric Outpatient Clinic Referral Form here.