Transcranial magnetic stimulation (TMS) and veteran status

Dear Editor,

Major depressive disorder (MDD) is a common disorder which causes great suffering. Around 3.7% of cases end in suicide. Of MDD patients treated with routine/standard antidepressant medication, around one third do not remit. ¹ Transcranial magnetic stimulation (TMS) is a noninvasive method of stimulating the cortex using electromagnetic technology – it has a strong antidepressant effect. Importantly, TMS brings remission to at least half those who have not responded to standard medication. ² TMS is a great advance in the field of MDD treatment.

Unfortunately, those people who fail to improve satisfactorily with medication, but achieve remission with TMS, often continue to suffer mood issues. MDD, particularly the treatment resistant form which comes to TMS and ECT, is likely to relapse within a year of achieving remission. TMS and ECT are proven acute treatments, but they may not cure MDD which rests on multiple etiological and pathological features. For both TMS and ECT, access to additional acute treatments and maintenance treatment is highly desirable. Currently, in Australia, while these are available for ECT, only acute TMS treatment is available.

A standard TMS treatment takes about half an hour – courses are generally composed of 35 treatments, one per weekday and extend over 7 weeks. Maintenance treatment can take different forms; an effective form is 5 treatments over 2.5–5 days once per month or 6 weeks or less often. ³

From November 2021, the Australian Medicare Benefits Schedule (MBS) provided rebates for acute TMS for MDD. A lifetime limit of 50 acute treatments was declared. This is a lifetime limit of less than two courses. Maintenance TMS has not received rebates.

As MDD is a frequently relapsing disorder, the current rebate arrangement is unsatisfactory – people who receive one effective course are allowed less than a half a second course and no further rebated TMS care.

However, excellent news for veterans arrived recently. From 1 January 2026, Department of Veterans’ Affairs (DVA) patients with MDD unresponsive to medication will be allowed 100 sessions per year, with a lifetime limit of 300 sessions ⁴ (these to commence after the MBS 50 treatments have been exhausted). It is yet to be clarified if any of these treatments can be used in the provision of maintenance treatment. 300 sessions would provide almost 9 acute courses which is more than most patients are likely to require. A year of maintenance treatment would absorb only 40–50 sessions – it would make sense, for the DVA to allow this valuable form of treatment.

MDD is a great burden. TMS is a proven and economically superior treatment. ⁵ Australia promotes equal opportunities for its people. Non-veterans should receive the same quality of care as veterans – or an interesting explanation to the contrary. ⁶