Key Takeaways
- Same Goal, Different Delivery: Both rTMS and iTBS are non-invasive procedures that use magnetic pulses to stimulate nerve cells in the brain to treat depression.
- Time is the Main Difference: A standard rTMS session typically lasts between 20 to 40 minutes, while an iTBS session is much faster, taking only about 3 to 10 minutes.
- Equal Effectiveness: Clinical studies suggest that iTBS is just as effective as standard rTMS in reducing depressive symptoms.
- Diamond Edge TMS is Here to Help: As an expert provider of transcranial magnetic stimulation (TMS) services in WA, Diamond Edge TMS specializes in guiding patients toward the protocol that best fits their lifestyle and medical needs. Contact Diamond Edge TMS today to schedule your consultation.
Understanding the Basics of TMS
For the millions of adults struggling with Major Depressive Disorder (MDD), finding a treatment that works can be a long, exhausting road. When antidepressants and talk therapy fail to provide relief, Transcranial Magnetic Stimulation (TMS) often offers a new path forward. However, patients researching this life-changing treatment often encounter a confusing fork in the road: the choice between traditional rTMS and the newer iTBS.
Before diving into the specific differences, it helps to understand the shared foundation of these treatments. TMS is an FDA-cleared treatment for depression that targets the prefrontal cortex, which is the area of the brain associated with mood regulation.
Unlike Electroconvulsive Therapy (ECT), TMS does not require anesthesia or sedation. Patients remain awake and alert throughout the procedure. A treatment coil is placed against the scalp, delivering magnetic pulses that stimulate underactive neurons. Over the course of treatment (typically several weeks), this stimulation helps reset the brain's mood pathways.
Both rTMS and iTMS use magnetic fields to stimulate the brain and alleviate symptoms of depression, but they differ significantly in how the treatment is delivered. Understanding the nuances between Repetitive Transcranial Magnetic Stimulation (rTMS) and Intermittent Theta Burst Stimulation (iTBS) is the first step toward reclaiming your mental health.
What is Repetitive TMS (rTMS)?
Repetitive Transcranial Magnetic Stimulation, often just called rTMS, is the original standard protocol. The FDA first cleared it for the treatment of depression in 2008.
During an rTMS session, the magnetic coil delivers pulses at a steady, repetitive rhythm. These pulses occur at a specific frequency (usually 10Hz for high-frequency stimulation). Because the pulses are spaced out, the brain requires a longer period of stimulation to achieve the desired therapeutic effect.
For over a decade, rTMS has been the go-to option for providers and patients. It has a robust history of safety and efficacy data backing it up, making it a reliable choice for those seeking an alternative to medication.
What is Intermittent Theta Burst Stimulation (iTBS)?
Intermittent Theta Burst Stimulation (iTBS) is a newer, more advanced form of TMS. Like rTMS, this protocol is in wide use and standardized. While it uses the same magnetic technology as rTMS, the pattern of delivery is different.
iTBS mimics the brain’s natural internal rhythms, known as theta waves. Instead of a steady stream of pulses, iTBS delivers 'bursts' of stimulation—specifically, three pulses at 50Hz, repeated five times per second. This patterned approach is much more efficient at increasing brain excitability.
Because the brain responds more readily to this natural rhythm, iTBS can achieve the same number of effective pulses in a fraction of the time required for rTMS.
rTMS vs. iTBS: Comparing the Differences
While relief from depression is the goal for both, the patient experience varies. Here is how the two compare across critical categories.
Treatment Duration
This is the most significant factor for most patients. A standard rTMS session generally requires 19 to 37 minutes in the chair. Since a full course of treatment involves sessions five days a week for six to eight weeks, this time commitment can be substantial.
In contrast, iTBS is designed for efficiency. A typical session lasts just over 3 minutes. This allows patients to fit treatment into a lunch break or a brief stop on the way to work without disrupting their entire day.
Clinical Efficacy
Is faster actually better? Or is it just faster? The largest study comparing the two, known as the 'THREE-D' trial, published in The Lancet, confirmed that iTBS is 'non-inferior' to rTMS. In simple terms, patients receiving the 3-minute treatment saw virtually the same reduction in depression symptoms and remission rates as those receiving the longer treatment.
Comfort and Side Effects
Both treatments share a similar safety profile. Common side effects include mild scalp discomfort during stimulation or a slight headache afterward. Because iTBS delivers energy in more intense bursts, most patients might find the sensation uncomfortable but brief. Many acclimate to it quickly. However, if you are highly sensitive, rTMS is usually much easier to tolerate.
Comparison Summary
| Feature | Standard rTMS | iTBS (Theta Burst) |
|---|---|---|
| Session Length | 19–37 minutes | 3–10 minutes |
| FDA Clearance | 2008 | 2018 |
| Pulse Pattern | Repetitive, steady pulses | Rapid, high-frequency bursts |
| Efficacy | Highly effective | Equally effective (Non-inferior) |
| Mechanism | Stimulates neurons via repetition | Mimics natural brain rhythms |
Choosing the Right Protocol for You
Deciding between rTMS and iTBS often comes down to logistics and personal preference rather than medical outcome, given their similar success rates.
You might prefer iTBS if:
- You have a busy work schedule or limited time.
- You want to minimize the time spent in a medical office.
- You have difficulty sitting still for 30+ minutes.
You might prefer rTMS if:
- You prefer the longer-established protocol.
- You find the sensation of the rapid bursts in iTBS too intense.
- Your specific insurance plan has restrictions that favor the standard protocol.
Diamond Edge TMS works closely with every patient to verify insurance benefits and determine which protocol fits best within their specific coverage plan.
Start Your Journey to Remission with Diamond Edge TMS
Depression should not define your life, and medication is not your only option. Whether you choose the established path of rTMS or the efficient innovation of iTBS, the destination is the same: a life with fewer symptoms and more joy. Diamond Edge TMS provides compassionate, expert care to help residents of WA navigate these options and find the relief they deserve.
Schedule your appointment with Diamond Edge TMS today and discover if TMS therapy is the solution you have been waiting for.
Frequently Asked Questions
Is iTBS more expensive than standard rTMS?
The cost for both treatments is the same. They use the same device and coil. Their billing codes are identical. However, some insurers will cover rTMS while they will not pay for iTBS. Diamond Edge TMS helps patients verify their benefits prior to starting treatment.
Is Theta Burst Stimulation safe for everyone?
iTBS carries the same general safety precautions as rTMS. It is not suitable for patients with non-removable metal in their head or a history of seizures. A thorough medical evaluation is required to ensure candidacy for either form of TMS.
How quickly will I see results?
Response times vary by individual. rTMS patients can notice improvements in sleep and energy within days. Mood improvements typically become noticeable around the second or third week of treatment. With iTBS, response can occur more rapidly – within one or two days.
