Who they may suit
Adults with depression that has not responded enough to one or more adequate trials of medication, people who cannot tolerate medication, and people who would rather add a non-drug treatment than change medication again. Whether either treatment suits you, and which, is decided together at a psychiatric assessment, which also rules out the few situations in which they should not be used.
Dr Szigeti
I am certified in tDCS and rTMS and a member of the Academy of Brain Stimulation, and I provide neuromodulation at St John of God University Hospital. At Seaward Clinic I offer tDCS directly; for rTMS I assess whether it is right for you and refer you to a colleague who provides it, and I remain your psychiatrist throughout. To find out whether either could be an option for you, get in touch.
tDCS: at home, under supervision
Transcranial direct current stimulation: a very weak, painless current, applied through small pads placed on the head, gently increases the activity of the brain areas that regulate mood. The device is small and portable, and the sessions take place at home, usually daily for a few weeks, following a plan agreed with Dr Szigeti. Side effects are mild, usually a tingling or itching under the pads. The evidence supports it as an option for mild to moderate depression and as an addition to medication; it is not yet a substitute for every other treatment, and it is discussed as one option among several.
- A psychiatric assessment, which includes whether tDCS is suitable for you.
- The course, the sessions and the reviews are explained in detail, and the cost confirmed in writing, before anything starts.
- You use the device at home, with thirty-minute reviews during and after the course.
rTMS: by referral to a colleague
Repetitive transcranial magnetic stimulation: a coil held against the scalp delivers brief magnetic pulses that stimulate the part of the brain involved in regulating mood. It needs no anaesthetic, and you go home after each session. A course is typically a session of twenty to forty minutes on most weekdays for four to six weeks, in a clinic with the equipment and trained staff. Side effects are usually limited to some scalp discomfort during the first sessions; it is not used for people with certain metal implants in the head, and it needs care where there is a history of seizures. It is an established treatment for depression that has not responded to medication, recognised by NICE guidance and used in Ireland in a small number of specialist clinics.
- A psychiatric assessment with Dr Szigeti, which includes whether rTMS is the right option for you and whether anything rules it out.
- If it is, Dr Szigeti refers you to a psychiatrist colleague who provides rTMS, and tells you what to expect from that clinic, including its waiting time and fees. The course takes place there.
- Dr Szigeti remains your psychiatrist before, during and after the course: your medication, your follow-ups and your GP’s letters stay with him.
All treatment options are discussed with you before anything is prescribed or started, including their risks and benefits.
Fees
The assessment that comes first is €500 and follow-ups are €180. rTMS is provided and charged by the colleague’s clinic that delivers it; Dr Szigeti’s assessment and follow-ups are charged as above. Fees and insurance