New rTMS Program Offers Hope for Treatment Resistant Depression

UBMD Physicians’ Group has introduced a new repetitive transcranial magnetic stimulation (rTMS) program at Erie County Medical Center (ECMC), expanding access to an innovative, non‑invasive treatment option for patients struggling with treatment‑resistant mental health conditions. Led by Dr. Raphael Leo, Associate Professor at the Jacobs School of Medicine and Biomedical Sciences, the program provides an evidence‑based alternative for individuals who have not found relief through traditional medications or therapies. rTMS uses focused magnetic pulses to stimulate specific neural circuits in the brain associated with mood regulation. Unlike electroconvulsive therapy (ECT), rTMS does not require anesthesia, sedation, or recovery time. It is primarily used to help with treatment‑resistant depression and obsessive‑compulsive disorder.

“It’s very well tolerated, FDA‑approved, and it has demonstrated an ability to improve patients who have not been able to respond well to standard treatments,” said Dr. Leo. “Patients can come in for a brief session and immediately return to their daily routines.”

What Patients Can Expect from Treatment

A typical rTMS session lasts 20 to 30 minutes, during which patients may feel a gentle tapping sensation on the scalp. The treatment involves the administration of approximately 3,000 magnetic pulses per session, five days a week, over a six‑week course.

For some patients, treatment can be delivered even more quickly using a method called theta burst stimulation, reducing sessions to as little as 3 to 10 minutes.

Side effects are generally mild, limited to temporary scalp discomfort or headaches. A rare risk of seizure exists, but, as Dr. Leo emphasizes, “this risk is extremely low when safety guidelines are followed.”

Patients can talk, watch TV, or simply relax during their session; no sedation or transportation assistance is required, and patients experience no cognitive impairment.

Managing Life While Undergoing Treatment

While the six‑week, Monday - Friday schedule requires commitment, occasional missed sessions are manageable.

“Life happens. Snowstorms, illness, work travel,” Dr. Leo said. “Missing a few days will not disrupt treatment. We try to go out of our way, whenever possible, to accommodate interruptions.” Dr. Leo has even come in on weekends to administer treatment when necessary.

Assessing Candidacy and Measuring Success

Patients are typically referred by psychiatrists, primary care providers, psychologists, or advanced practice clinicians. Candidates must meet criteria for treatment‑resistant depression or OCD as defined by insurance providers, usually meaning multiple unsuccessful trials of antidepressant therapy.

Before beginning rTMS, each patient receives a comprehensive psychiatric assessment and medical review. Progress is measured continuously through daily clinical interactions and through standardized scales administered at two, four, and six weeks, and again two months post‑treatment.

Patient response varies. Some notice improvements within days; others progress more gradually. Most experience benefits lasting at least three months, especially when rTMS is paired with ongoing psychiatric care, something that Dr. Leo stresses the importance of.

Why UBMD’s rTMS Program Stands Apart

While some private clinics also offer rTMS, UBMD’s program is built within a fully integrated academic medical system, ensuring patients receive coordinated, comprehensive care.

“In isolated treatment centers, it can be difficult to integrate follow‑up, manage setbacks, or coordinate future care,” Dr. Leo explained. “At UBMD, we evaluate patients carefully, monitor their progress, and integrate treatment with existing services. Our priority is delivering rTMS thoughtfully and consistently.”

The program’s academic foundation also ensures continuous quality improvement, outcomes monitoring, and refinement of clinical processes.

A New Era of Training for Medical Residents

The launch of the rTMS program also represents a transformational opportunity for education. Until this program, UB psychiatry residents learned about neuromodulation only through lectures—never firsthand.

“This program wouldn’t exist without strong departmental leadership, particularly from Dr. Beth Smith (UBMD Chair of Psychiatry),” Dr. Leo said. “Now residents see rTMS in action. They’re excited, they’re engaged, and it has expanded their whole neuromodulation training experience.”

As the program matures, UBMD plans to expand resident involvement, develop scholarly and quality improvement opportunities, and eventually pursue long‑term research studies.

Looking Ahead

Dr. Leo is encouraged by the early successes of the program and energized by the enthusiasm of both patients and learners.

“I'm very encouraged by the responses of the patients we’ve treated and how much they've improved,” he said. “And I’m excited by how passionate our residents are. They're really invested in learning about rTMS.”

With its new rTMS program at ECMC, UBMD Physicians’ Group builds on its mission to provide exceptional patient care while advancing education and research, bringing hope and innovative treatment options to Western New Yorkers who need them most.

For more information, or to schedule an assessment, call UBMD Psychiatry at (716) 898-4857.