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Evidence to Improve Care

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression


Ontario Health Technology Advisory Committee Recommendation

The Ontario Health Technology Advisory Committee recognizes that electroconvulsive therapy is the most effective treatment for non-psychotic, treatment-resistant depression. The Committee therefore recommends that repetitive transcranial magnetic stimulation be publicly funded for patients with non-psychotic, treatment-resistant depression only when electroconvulsive therapy is not an option.

Read the full OHTAC Recommendation report



Treatment-resistant depression — a form of depression that does not improve with antidepressant medication or psychological counselling — is reasonably common. We estimate that between 100,000 and 200,000 Ontarians suffer from treatment-resistant depression.

The most effective treatment for treatment-resistant depression is electroconvulsive therapy. Electroconvulsive therapy involves doctors using a machine to send a brief electrical signal to a patient’s brain to cause a generalized seizure. The patient does not experience convulsions due to anesthesia.

In spite of the availability of new electroconvulsive therapy techniques that have significantly reduced side effects, some patients do not want to have electroconvulsive therapy because they fear medical complications or side-effects like memory loss. In a small number of cases, patients are ineligible for electroconvulsive therapy because the treatment is unsafe for their health. In other circumstances physicians do not offer electroconvulsive therapy, limiting access to patients who may be candidates for the treatment.

Repetitive transcranial magnetic stimulation is a non-invasive technique that does not require anesthesia and delivers intense magnetic pulses into the brain. It can be used as a possible alternative for patients who cannot have electroconvulsive therapy. The aim is to stimulate the area of the brain associated with mood regulation to help treat symptoms of depression.


Health Quality Ontario Reviews Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression

Based on the evidence, Health Quality Ontario concluded that electroconvulsive therapy provides better outcomes for patients with treatment-resistant depression, but recommends that repetitive transcranial magnetic stimulation be publicly funded for patients where electroconvulsive therapy is not an option.


Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (PDF)
March 2016

Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: An Economic Analysis (PDF)
March 2016


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The Ministry of Health and Long-Term Care is currently reviewing this recommendation.

The Ministry of Health and Long-Term Care has provided the following response: The Ministry has a standardized process in place to review Health Quality Ontario recommendations. This takes into consideration Ministry priorities, implementation options, the need for consultation with impacted stakeholders, and funding considerations.




Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee (OHTAC) — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.



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