Status: Individual prior approval
Effective date: 1 April 2026
Next review date: 1 April 2028
Essex ICB commissions repetitive Transcranial Magnetic Stimulation (rTMS) on a restricted basis for treatment-resistant depression for adults aged 18 years and over who meet all eligibility criteria set out in this policy.
Essex ICB does not commission Transcranial Magnetic Stimulation (TMS), including repetitive TMS (rTMS), for any indication other than treatment resistant depression in adults where Electroconvulsive Therapy (ECT) is clinically contraindicated. No other use of TMS or rTMS is funded under this policy, and requests for alternative mental health, neurological or physical health conditions will not be supported. –
rTMS forms part of the Essex ICB commissioned adult secondary mental health pathway and is delivered exclusively by the ICB’s contracted adult mental health provider. Referrals for rTMS must originate only from the consultant psychiatrist who holds ongoing clinical responsibility for the patient within the ICB commissioned NHS secondary mental health service.
Individual prior approval
Funding for rTMS under this policy will only be approved when all of the following eligibility criteria are met:
A. Age and diagnosis
The patient must 18 years or over with a confirmed diagnosis of treatment resistant depression (TRD). TRD must be evidenced by:
- inadequate response to at least two antidepressants, each prescribed at an appropriate therapeutic dose and duration, and
- completion of an appropriate psychological therapy intervention delivered in line with the local care pathway
B. ECT Clinically contraindicated
- ECT is clinically contraindicated. This includes, but is not limited to:
- significant anaesthetic risk,
- frailty or medical comorbidities that increase procedural risk, and
- perinatal clinical safety concerns where ECT is assessed to present unacceptable risk.
The referring consultant psychiatrist must clearly document the specific clinical contraindication to ECT.
C. Consent, suitability and safety
The patient must:
- have capacity to provide informed consent,
- be able to comply with the treatment schedule (frequent sessions over a short period), and
- have no contraindications to rTMS as defined in the service’s clinical protocols (e.g., implants, neurological risk factors).
D. MDT confirmation
A multidisciplinary team (MDT) with expertise in affective disorders and neuromodulation must:
- confirm that rTMS is the next clinically appropriate step,
- verify that all conventional treatments, including ECT, have been exhausted or ruled out on clinical grounds, and
- ensure baseline outcome measures are recorded prior to treatment.
Individual Prior Approval (IPA) is mandatory for all rTMS treatment, including both:
- initial rTMS, and
- any rescue rTMS following relapse.
- Rescue rTMS will only be approved only where:
- the patient previously demonstrated a clear, clinically meaningful benefit to an initial IPA approved rTMS course for at least 6 months after completion of the course,
- ECT continues to be clinically contraindicated, and
- the application includes objective evidence of relapse, expected benefit, and a time limited proposed treatment plan.
Not funded under this policy
The following will not be commissioned:
- rTMS in any case where ECT remains clinically appropriate and is not contraindicated.
- rTMS for any indication other than treatment resistant depression
- rTMS where psychological or pharmacological treatments have not been adequately attempted unless there is a documented clinical justification for deviation.
- Maintenance rTMS
- rTMS where the patient does not meet all mandatory eligibility criteria set out in this policy
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Further information on applying for funding in exceptional clinical circumstances can be found on the ICB website.