There's a new option for hard-to-treat depression in Ottawa

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Unlike ECT, which stimulates the whole brain, rTMS uses magnetic fields to activate specific areas of the brain involved in mood regulation, he said.

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Patients remain awake throughout the procedure and can return to normal activities immediately afterward.

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ECT, Kaluzienski noted, is more complex. “Patients stay in the hospital for a while until they get better, and then they need someone to accompany them home.”

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Why rTMS wasn’t widely available — until now

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The greatest barrier has been cost. rTMS treatment in Ontario can cost thousands for the standard 30‑session protocol.

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“It’s a resource that’s never been on the table for us,” Kaluzienski said. “To call a patient and say, ‘This is a great idea, but I can’t offer it to you,’ is obviously difficult for both the patient and the physician.”

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That changed last year, when Ontario announced funding for clinical rTMS programs, investing $5.4 million to expand access to treatment for adults living with difficult-to-treat depression.

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“Approximately $568,370 has been allocated to support service delivery at The Royal. The treatment can cost up to $6,000 when not publicly funded,” The Royal’s news release read.

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The Royal already had rTMS machines for research purposes, but the new provincial program allows it to provide publicly funded treatments.

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Kaluzienski says The Ottawa Hospital is currently only conducting research in rTMS, but it has purchased rTMS machines and plans to hire technicians to expand care.

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“Having the option is a game-changer,” Kaluzienski said. “It’s exciting that the system is looking for co-ordinated access to care. It’s important for us to work together as institutions to make sure it’s easier for patients to access the care they need.”

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Research co-ordinator and rTMS technician Rosalie Létourneau, right, demonstrates rTMS on her colleague, Jessica Drodge, staff interventional psychiatry research co-ordinator at The Royal. Photo by Jean Levac /Postmedia

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Is rTMS more effective than ECT?

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Brender says clinical studies show rTMS is both safe and effective, with a response rate of about 50 per cent and a remission rate between 30 and 40 per cent.

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“Response means symptoms improve and remission means the patient returns to their pre‑depression baseline,” Brender says.

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However, ECT has higher response (70 per cent) and remission (50 per cent) rates than rTMS.

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“Overall ECT is more effective, but the side-effects are more significant,” Brender said, adding that rTMS had very few side-effects and a low withdrawal rate.

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rTMS to fill a treatment gap in Ottawa, doctors say

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The Canadian Mental Health Association reports that one in five Canadians experience mental health disorders.

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Brender says roughly one in six will experience major depression and one‑third of those — about two million people — live with treatment‑resistant depression.

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In the Ottawa region, Brender says, an estimated 50,000 to 60,000 people fall into that category.

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“This is quite a huge number, if you think about it,” he said.

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rTMS was developed in the 1980s and approved by Health Canada for clinical use in 2002. Brender says the United States made that move in 2008.

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“We are quite pioneers in this field and quite leading in the world, actually, with research regarding this machine,” he said.

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Through Ontario’s Neurostimulation Procedures Provincial Program, 18 publicly funded rTMS devices will be available across 15 clinical sites.

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They will provide access for more than 2,000 patients annually, Brender said.

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