Deep TMS (dTMS) private in London.

Deep TMS is a non-invasive brain-stimulation therapy delivered through the BrainsWay H-coil, a helmet worn over the scalp. Brief, focused magnetic pulses induce small electrical currents in the cortex, modulating activity in circuits that regulate mood, reward and compulsive behaviour.

The important difference from standard rTMS, which uses a figure-of-eight coil, is depth. The H-coil field reaches roughly three to five centimetres beneath the skull, engaging deeper prefrontal and cingulate structures that a figure-of-eight coil only touches at the surface. The trade-off is a slightly broader field, so precise focality is lower, but the deeper penetration matters for depression and OCD circuits.

BrainsWay deep TMS carries FDA clearance for major depressive disorder (2013), obsessive compulsive disorder (2018) and short-term smoking cessation (2020). The device is CE marked and used across NHS and private psychiatry in the UK. In London, private centres typically run the newer BrainsWay 360 platform with H1 and H7 coils.

A standard course is 20 to 30 sessions delivered five days a week for four to six weeks, followed by a taper over two to three weeks. Each session lasts 20 to 30 minutes; you are awake, seated in a chair, and can read or listen to music between pulse trains.

For depression, the clinician uses the H1 coil positioned over the dorsolateral and medial prefrontal cortex. Motor threshold is established at the first visit by finding the pulse intensity that produces a small thumb twitch, and treatment is given at 100 to 120 percent of that threshold.

For OCD, the H7 coil sits further forward over the medial prefrontal cortex and anterior cingulate. Before each session the clinician runs a brief symptom-provocation script, tailored to your obsessions, to activate the target circuit so the pulse train has something to modulate.

Maintenance and top-up sessions are common. Many patients have a single booster session every four to six weeks for six to twelve months after a successful course, or a short block of five to ten sessions at the first sign of relapse.

The pulses feel like firm, rhythmic tapping on the scalp. Many patients describe a brief muscle contraction in the forehead or jaw with each train, which settles as the session progresses. The noise is a sharp clicking, so foam earplugs are always worn.

Mild headache in the first three to five sessions is the commonest side effect and responds to paracetamol. Scalp tenderness fades over the first week as the tissue habituates. There is no anaesthesia, no sedation, no cannula and no recovery time. You drive yourself home, return to work the same day, and can operate machinery.

For treatment-resistant major depression, remission rates at the end of a six-week BrainsWay course sit around 30 to 40 percent, with response rates (a 50 percent drop in the Hamilton or Montgomery-Åsberg score) of 50 to 60 percent. These figures come from the pivotal multicentre trial and are supported by post-market registry data across more than a thousand UK patients.

For OCD, the H7 protocol delivers a mean YBOCS reduction of 30 to 40 percent after six weeks, with response rates around 40 percent. Response tends to be gradual and to continue for four to six weeks after the course finishes, so early sessions can feel underwhelming.

Head-to-head comparisons with standard figure-of-eight rTMS suggest broadly comparable outcomes for depression, with deep TMS carrying the deeper penetration and figure-of-eight the tighter focality. Both are considered first-line neuromodulation options in NICE and Royal College guidance.

Standard rTMS uses a figure-of-eight coil, penetrates roughly one to two centimetres and is generally cheaper (about £3,000 to £5,000 for a course). Outcomes for depression are broadly comparable to deep TMS in head-to-head studies, so the choice often comes down to which coil a clinic runs and whether the target circuit needs deeper reach (as in OCD).

Electroconvulsive therapy remains the most effective treatment for severe, life-threatening depression, especially with psychotic features or catatonia, with remission rates of 60 to 80 percent. The trade-off is general anaesthesia, muscle relaxant, seizure induction and short-term memory side effects that persist for weeks in some patients. Deep TMS is the preferred first neuromodulation step for most treatment-resistant patients; ECT is reserved for those who fail TMS or need faster response.