At The Clinic of Change, innovation is a core principle. That is why we are constantly seeking new therapies and clinical approaches. In 2026, we will have a new tool at our disposal for mental health: Transcranial Magnetic Stimulation ( TMS).
This is a noninvasive brain neuromodulation technique that uses high-intensity pulsed magnetic fields to induce focal electrical currents in the cerebral cortex, modulating neuronal activity in a controlled and repeatable manner. In cases of treatment-resistant depression, studies show that the application of high-frequency repetitive stimulation in this region promotes increased local cortical activity and functional reorganization of fronto-limbic networks, contributing to symptomatic improvement.
What else does the scientific evidence tell us about TMS?
- Favorable safety profile;
- The procedure is performed on an outpatient basis, without the need for anesthesia or sedation;
- Effect on functional brain connectivity beyond the immediate period of stimulation;
- Increasing integration of international guidelines in the treatment of treatment-resistant depression;
- Significant results in the treatment of anxiety and obsessive-compulsive disorder (OCD).
Our clinical team has specialized training in TMS and has developed its practice based on validated international protocols aligned with leading centers in the field of neuromodulation.
The procedure is performed under the continuous supervision of a psychiatrist, in collaboration with a multidisciplinary team, ensuring safety, technical precision, and clinical monitoring at every stage of treatment. This ensures that the standard of care in Portugal is on par with that provided at leading international centers in this field.
The State of Mental Health in Portugal
Mental health is currently one of the leading causes of functional disability and lost productivity in Portugal and Europe. According to the Global Burden of Disease 2019 study, published in The Lancet, treatment-resistant depression and anxiety disorders are among the leading causes of Disability-Adjusted Life Years (DALYs), continuing to have an extremely significant clinical, social, and economic impact.
It is estimated that approximately 5% of the global adult population suffers from depression at some point in their lives, with 30% to 40% of patients developing forms of the disorder that are resistant to conventional pharmacological treatment. Anxiety disorders have an annual prevalence of over 7%, while Obsessive-Compulsive Disorder (OCD) affects approximately 2% to 3% of the population over the course of a lifetime.
The economic impact is equally significant, not only because of the direct costs associated with medical visits, hospitalizations, and medication, but also—and above all—because of the indirect costs related to work disability, absenteeism, presenteeism, and early retirement.
Given this situation, it is essential to incorporate innovative therapeutic interventions, backed by robust scientific evidence, that offer effective alternatives in cases of treatment resistance. It is in this context that Transcranial Magnetic Stimulation (TMS) emerges as one of the most significant and promising interventions in contemporary psychiatry.
The Clinic of Change
Founded in 2023 and headquartered in Lisbon, The Clinic of Change integrates neuromodulation approaches based on international scientific evidence, through structured clinical protocols, specialized psychiatric evaluation, and rigorous monitoring of therapeutic outcomes. TMS treatment is performed according to internationally validated protocols, using certified equipment, and adhering to high standards of clinical safety and strict eligibility criteria.
Statistics and Scientific Evidence
Mental disorders remain among the leading causes of disability and reduced quality of life worldwide. Among them, treatment-resistant depression stands out as one of the conditions with the greatest functional, social, and economic impact, and remains one of the leading global causes of years lived with disability, according to data from the Global Burden of Disease study.
Treatment-Resistant Depression (TRD) represents one of the greatest challenges in modern psychiatry. It is generally diagnosed when there is no adequate response after at least two properly conducted attempts at antidepressant treatment. Studies show that the likelihood of remission decreases progressively with each new line of treatment, underscoring the need for effective alternatives.
Obsessive-Compulsive Disorder (OCD) often has a chronic and disabling course. Although effective first-line treatments exist, such as SSRIs and cognitive-behavioral therapy, between 40% and 60% of patients do not achieve complete remission and continue to experience significant symptoms.
Anxiety disorders are also a major cause of psychiatric morbidity and often co-occur with depression. This association is linked to greater clinical severity, a poorer prognosis, and a poorer response to conventional treatments.
In this context, noninvasive neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have taken on an increasingly prominent role in international guidelines, demonstrating efficacy in modulating brain circuits involved in depression and other psychiatric disorders.
What does the scientific evidence tell us?
The efficacy of TMS in treatment-resistant depression has been well demonstrated in international studies. Clinical trials have shown that TMS is superior to sham stimulation, with benefits that are sustained over time. The THREE-D study, published in The Lancet, further confirmed that the iTBS protocol offers efficacy equivalent to conventional rTMS, with significantly shorter sessions.
Meta-analyses indicate:
- Response rates: 50% to 60%
- Remission rates: 30% to 40%
These results are particularly relevant in cases that are resistant to drug treatment.
Clinical studies have shown that Deep TMS can clinically and significantly reduce obsessive-compulsive symptoms, forming the basis for approval by the U.S. Food and Drug Administration for this indication. Recent meta-analyses also demonstrate a significant reduction in anxiety symptoms with rTMS, particularly in generalized anxiety disorder and in anxiety associated with depression.
Although formal approval focuses primarily on depression and COPD, its clinical use for anxiety is supported by a growing body of scientific evidence and specialized clinical practice.
But these are not the only issues where TMS can be used with proven, positive results. In the case of addictive behaviors, the therapy has been approved by the FDA (United States), particularly for smoking cessation. In Europe, this technology has also been approved for the treatment of cocaine addiction.
What is Transcranial Magnetic Stimulation, and how does it work?
Transcranial Magnetic Stimulation (TMS) is a noninvasive brain neuromodulation technique that uses pulsed magnetic fields to stimulate specific areas of the brain and modulate neuronal activity in a safe and controlled manner.
In clinical practice, TMS targets brain circuits involved in psychiatric disorders, such as treatment-resistant depression, where it can increase activity in the prefrontal cortex and improve emotional regulation.
There are various therapeutic modalities, including conventional rTMS, iTBS—which allows for shorter sessions with similar efficacy—and Deep TMS, which is capable of reaching deeper brain regions and is particularly effective for Obsessive-Compulsive Disorder (OCD).
The treatment is performed on an outpatient basis, without anesthesia or sedation. Sessions last between 3 and 37 minutes, depending on the protocol, and are generally conducted five times a week for four to six weeks. The patient remains awake and can resume their normal activities immediately.
TMS has a favorable safety profile. The most common side effects are mild and transient, such as scalp discomfort or mild headaches. Unlike many drug treatments, it is not typically associated with weight gain, sexual dysfunction, or negative cognitive effects.
Currently, TMS is considered a significant treatment option for treatment-resistant depression, with increasing inclusion in international clinical guidelines and expanding use in other areas of psychiatry.
International approvals
Transcranial Magnetic Stimulation (TMS) is currently recognized and approved by leading international organizations for the treatment of certain psychiatric disorders. The U.S. Food and Drug Administration approved rTMS in 2008 for treatment-resistant major depression, subsequently expanding the indications to other protocols, including Deep TMS. In 2018, it also approved Deep TMS for Obsessive-Compulsive Disorder (OCD).
In the European context, the National Institute for Health and Care Excellence has issued favorable recommendations for the use of TMS in depression and COPD, recognizing adequate evidence of efficacy and safety, particularly in specialized centers.
These international validations reinforce TMS as a credible, safe clinical intervention based on robust scientific evidence.
A TMS apresenta um perfil de segurança muito favorável, sendo geralmente bem tolerada. Os efeitos adversos mais comuns são ligeiros e transitórios, como cefaleia ou desconforto local. O risco de convulsão é extremamente raro (<0,1%), inferior ao observado com vários psicofármacos. Além disso, não está associada a efeitos cognitivos adversos, metabólicos, sexuais ou sistémicos, apresentando uma tolerabilidade substancialmente superior à eletroconvulsivoterapia.
TMS at The Clinic of Change
The clinical team at The Clinic of Change has specialized training in Transcranial Magnetic Stimulation (TMS) and has developed its practice based on validated international protocols aligned with leading centers in the field of neuromodulation.
The procedure is performed under the continuous supervision of a psychiatrist, in collaboration with a multidisciplinary team specifically trained in the administration of TMS, ensuring safety, technical precision, and clinical monitoring at every stage of treatment. This ensures that the standard of care in Portugal is on par with that provided at leading international centers in this field.
During all sessions, treatment takes place in a clinical setting with the constant support of a specialized team. A psychiatrist is always present at the clinic, responsible for overall clinical supervision, as well as a psychologist, who ensures the therapeutic framework and patient follow-up. The technical execution of the procedure is performed by a TMS technician with specific certified training, who may be a nurse or psychologist with specialized training in this area. In certain circumstances, the roles of psychologist and TMS technician may be performed by the same professional, provided they are properly qualified, always ensuring the continuity, consistency, and safety of the intervention.
Our team combines extensive clinical experience in mental health with specialized expertise in neuromodulation, ensuring a rigorous, personalized, and evidence-based approach, with a doctor and nurse always present together during each session.
