Quebec urged to expand repetitive transcranial magnetic stimulation as INESSS recommends wider access
INESSS urges Quebec to expand repetitive transcranial magnetic stimulation (rTMS) access to treat treatment‑resistant depression amid equipment shortages.
Repetitive transcranial magnetic stimulation is being promoted by provincial experts as a scalable treatment for people with depression that has not responded to medication, and the Institut national d’excellence en santé et en services sociaux recommended in January 2026 that access be improved across Quebec.
Clinics such as the outpatient psychiatry unit in Rivière‑du‑Loup are treating growing numbers of patients with rTMS, while provincial data show only 17 machines are currently available.
The INESSS analysis proposes adding equipment and service capacity to reach thousands more patients over the next five years.
Rivière‑du‑Loup clinic treats increasing rTMS patients
In the late afternoon waiting room at Rivière‑du‑Loup hospital, several patients book the daily sessions that deliver magnetic pulses to precise areas of the brain.
One patient described the treatment as difficult but necessary, saying he sought to regain at least half of his former life after months of depression that did not improve with medication.
Health workers place a copper coil on the scalp and run short bursts of magnetic stimulation every few seconds while monitoring tolerance and clinical response.
Clinical outcomes and safety profile of rTMS
Clinicians cite remission rates of roughly 45 to 50 percent within four to six weeks for patients who have previously tried at least one antidepressant without sufficient benefit.
Common side effects are limited and mainly include scalp discomfort and headaches, and the treatment does not require general anaesthesia.
Health Canada approved repetitive transcranial magnetic stimulation in 2002, and Quebec’s public insurer has covered it since 2013, giving it an established regulatory and financing footprint.
INESSS recommends expanding access across Quebec
In an advisory released in January 2026, INESSS concluded that the evidence supports broader use and recommended concrete service modalities to improve equity of access.
The institute modelled scenarios in which the addition of 27 devices over five years would enable treatment for an estimated 7,504 additional people with treatment‑resistant depression.
INESSS also highlighted the uneven regional availability of services and called for planning that accounts for demand, workforce capacity and local delivery models.
Regional equipment gap and projected patient impact
Quebec currently houses 17 rTMS machines, concentrated in seven regions, leaving many areas without local access to the treatment.
Bas‑Saint‑Laurent stands out for treating the highest number of rTMS patients per 100,000 inhabitants, a pattern that reflects local clinical leadership rather than uniform provincial coverage.
In 2025, 536 patients received rTMS in Quebec, and INESSS estimates patient numbers could rise more than 200 percent if device availability increased.
Cost comparison with electroconvulsive therapy and policy implications
INESSS estimated that expanding rTMS capacity would require an investment of about $51.9 million over five years, a level described as modest relative to overall mental health program costs.
The institute notes that annual additional spending would amount to less than 0.25 percent of 2023‑24 mental health program expenditures, and that rTMS is roughly three times less costly than electroconvulsive therapy on comparable metrics.
Given efficacy and tolerability, INESSS suggested rTMS should generally be considered before ECT in treatment pathways and might be considered ahead of ketamine in some cases, while stressing the need for local implementation analyses.
Clinician perspectives and patient experience
Psychiatrists who have deployed rTMS describe strong clinical satisfaction from seeing patients improve and reduced reliance on more invasive treatments.
Providers say the routine of daily sessions over several weeks can itself support behavioural activation, an element that complements psychotherapeutic work.
Patients quoted by clinicians report meaningful relief from suicidal thoughts and functional recovery when other treatments had failed.
Decision making by the Ministry of Health and Social Services is pending, with officials saying they have taken note of the INESSS report and will undertake further analyses before setting policy.
As of June 14, 2026 the province faces a choice about investing in equipment, training and regional delivery to close gaps in access to repetitive transcranial magnetic stimulation for people with treatment‑resistant depression.
Provincial decisions in the coming months will determine whether thousands more Quebecers gain timely access to this treatment option.
