ECT and rTMS services

Our electro convulsive treatment (ECT) and repetitive transcranial magnetic stimulation (rTMS) services is available for patients being treated under Oxleas Foundation Trust. With funding in place (requires approval by a local CCG or referral from a Private Psychiatrist or medical insurance scheme) the service is also available for people outside of Oxleas Foundation Trust that reside in other London boroughs and the Medway areas.

Both services are based within new purpose-built premises in the Woodlands Unit at Queen Mary’s Hospital in Sidcup, Kent. The team is led by Dr Rafael Euba, our ECT Consultant and an expert in delivering rTMS.

ECT Service

Our ECT service is accredited as excellent by ECTAS, the Royal College of Psychiatrists ECT Accreditation Service. It is well established and provides an essential treatment for patients with very severe psychiatric symptoms of depression. We continue to receive extremely positive feedback from our patients.

rTMS Service

This service was launched in January 2017 for patients with a diagnosis of treatment resistant depression. This is a new treatment, included in the NICE guidelines in 2016, for both depression and migraine treatment.

At this time, we are able to provide this treatment for people with depression who are under our secondary mental health services and therefore residents of Bexley, Bromley and Greenwich. We have already seen some positive results in patients.

Please contact Dr Euba or Jeck Ding:
Tel: 020 3889 5168

Related Information

Woodlands Unit, Sidcup

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How to find us:

Bus routes:
160, 229, 269, 286, B14, R11

Trains travel regularly to Sidcup station from London Charing Cross, London Bridge, Waterloo East, Cannon Street and New Cross as well as Dartford, Gravesend, Slade Green and Crayford. The hospital is about 25 minutes walk from Sidcup station or you can take a bus or taxi – bus 229 and 286 run between the hospital grounds and the train station.

The hospital is beside the A20 Sidcup Bypass, and you should come off at Frognal Corner onto the A222. Queen Mary’s Hospital has public parking spaces with bays for people with disabilities outside each main building. Pay and display charges are made.


Woodlands Unit
Queen Mary's Hospital
Frognal Avenue

DA14 6LT

Public phone number:

020 3889 5168



I’ve had Obsessive Compulsive Disorder & depression for 24 years I’ve been on numerous medications and been to so many CBT/ERP therapy but nothing has helped. I’m so tired of it all and I’m getting no where when I ask the GP.

I’m in Bexley and I’m not sure if this is something that could be considered ?



Dear Kim

I am sorry that you have had long experience of difficulties treating OCD and depression. You may know that the National Institute for Clinical Excellence (NICE) recommends the NHS uses ECT (electro-convulsive therapy) to treat depression only in certain circumstances (ie for more severe presentations when other treatments have not been successful).

There is also a specific NICE guideline that recommends the NHS uses rTMS (repetitive Transcranial Magnetic Stimulation) to treat depression because it shows adequate but variable responses to this intervention.

Our ECT/rTMS service requires a GP referral so you would need to request this from your GP as this would provide important information about medical history.

I hope that is helpful.

Best wishes,

Jo Cook
Head of Psychological Therapies & Patient Experience
Bexley Care

Dear Sirs,
I was referred to Bromley ADAPT from the Perinatal Team as I would like to consider rTMS. I've not had much luck with SSRIs due to the side effects. Can you please advise when I can be seen?
Thank you very much

Dear Abi

We have passed on your question to the ADAPT service and a staff member will contact you shortly to advise you.

Kind regards

Adrian Dorney
Associate Director
Bromley Directorate

My wife is 50 years old, She has a long history of Clinical Depression going back to 1989. When she get's very low, her behavior becomes very challenging (self harm, suicide attempts, running away) etc. Over the last 30 years she has had numerous bad episodes resulting in hospitalisation and ECT as a last resort (40+ ECT treatments). She has had period of 10 years relative stability, but is now going downhill again. She is on Lithium, Venlafaxine, Olanzepine as well as type 2 diabetes medications. We have got nowhere with the local Sittingbourne MHT because she often presents well when they interview her. We wait weeks for an appointment and then they just discharge her again. Can you provide rTMS treatment for her please if we fund it ourselves? If so what would the costs be please?

Dear Graham

I am sorry to hear your wife is becoming unwell again and that you feel your local services are not being very responsive.

It sounds as if ECT has worked well in the past and rTMS could also be considered. However, given her past history, she would need to be supervised by her community team while having treatment.

In other words, if she was to have rTMS, we would need her current psychiatrist to refer your wife to us and she would need to be seen by a care coordinator at regular intervals.

I hope this helps.

Kind regards

Dr Rafael Euba
ECT and rTMS Lead


I wanted find out about the possibility of receiving treatment with ECT urgently for treatment resistant depression and suicidal ideation if I am able to pay. Currently under care of Merton home treatment team.

Thanks you.


Dear Leon

Thank you for leaving a message, and I'm sorry to hear how severe your depression has been.

All NHS organisations, including South West London & St George's (which covers your team in Merton), do have access to this if it is required and it is felt that the potential benefits out-weigh the risks.

I would strongly urge you to request a medical appointment within your Home Treatment Team to discuss this, and other options that might be available. I hope that things improve for you:

I think that it is positive that you can at least name some of these difficulties, and I would encourage you to continue that with your team.

Kind regards

Dr Derek Tracy
Clinical Director


Thank you very much for replying to questions regarding rTMS. I am considering undergoing the treatment from one of the private providers in London. Can you please tell whether the treatment is appreciably different depending on who is doing it? It seems in some cases psychiatrists initially determine coil placement, etc, where in others a technician does it. Additionally, it seems that the equipment manufacturer and coils vary as well. Also, do you feel a tapering off of treatment is beneficial or not? Thank you so much for your help. I have had a difficult time finding these answers when searching the web and when speaking to my psychiatrist.

Kind regards

Dear Nancy

Before the treatment starts, there is a need to decide what type of protocol should be used depending on the clinical presentation and a technician would not be be able to make this decision.

There is no evidence that any particular type of coil is superior to the others clinically.

Finally, tapering down may be good for those who feel apprehensive about terminating the treatment.

I hope this helps.

Kind regards

Dr Rafael Euba

I have depression a lot of my life. I don’t know if TMS would work for me. I would like to try it and would like to know how much I would pay per session. I take sertaline 200mg every day but I does not give me much relief. My doctor said it is not available on the nhs.

Thank you for your email Martina, and I'm sorry to hear about your ongoing struggles with depression.

rTMS is a new technique with some evidence for the treatment of depression (though this looks no better than 'ordinary' treatments and it can be hard to work out for whom it might be best suited).

rTMS is available in some NHS locations, including Oxleas, although referral for that needs to be by a consultant psychiatrist who feels, with you, that other talking therapies or medications would not be preferable.

You might wish to have a discussion with your GP about whether or not you feel together you have been able to manage your depression or not, and whether you might need a specialist review in mental health services. We could not promise that rTMS would be given, but it could be considered. I understand that rTMS is available in the private sector but unfortunately that is not something we can advise on.

Yours sincerely

Dr Derek Tracy
Clinical Director

I'm making enquiries on behalf of my daughter who suffers from Bipolar 1 and is generally severely depressed to the point where she is unable to function normally. Her depression has been resistant to most forms of treatment and medication. She saw Dr Euba last year in London as a private patient and had a course of rTMS treatment. Unfortunately, this did not provide any long lasting benefit and she is now considering ECT which Dr Euba mentioned could be an alternative if the rTMS did not work. Could you please advise the referral process to access ECT treatment either under the NHS, preferably, or as a private patient. My daughter lives outside of your Health Authority.

Thank you.


Dear Mark

Thank you for getting in touch.

Can you please call me on 020 8836 8670 so we can discuss matters further?

Kind regards

Dr Rafael Euba


I have been depressed/anhedonic for 9 years and have failed to respond to all medications (over 30) , and was wondering whether I could be referred for rTMS on the NHS? I live in a nearby London borough and see this as a fully viable option in finally treating my depression and regaining my life.

However I need to ask if were I to be referred, you would be willing to conduct the treatment on an area of the brain known as the orbitofrontal cortex? This is the only area of the brain that seems to respond to the emotional numbing type of depression/anhedonia that I have, and has many studies,evidence and anecdotes behind it of which I can provide.

As I understand it, NICE has not restricted this method of care, and it has been used extensively in the US now to alleviate the most treatment resistant cases(anhedonia and emotional numbing) I really feel that this is the only type of rTMS that can cure me , and being only 24 and having suffered like this for many years, I am pretty desperate to regain my life.

I hope you can be of assistance

Dear Albert

I am sorry to hear you have been unwell for so long. You are right to say that orbito-frontal rTMS appears to be an interesting and perhaps promising rTMS modality, but it would be delivered with a special coil, which we don't have, and more importantly, one would normally try the standard rTMS protocol to either the right or the left Dorso-lateral Prefrontal Cortex, as the evidence of effectiveness of this modality is much better at the moment.

Kind regards

Dr Rafael Euba

I am very interested in undertaking rTMS for treatment resistant depression and I have the funds in place to do so.

Before I proceed, however, I have two questions:

1) If I would like to undertake rTMS as a means to reduce or eliminate the medications I am taking, is it advisable to do this before or after rTMS therapy? I am worried that coming off medication afterwards may 'undo' the effect of rTMS.

2) If I would like to use rTMS to prevent relapse, what maintenance schedule is recommended if, for instance, I would like to take no medication. For instance, would one session per month be an adequate preventative measure? I am keen to maintain the effect of rTMS before I relapse and, therefore, avoid the cost of a repeat course of acute treatment.

I have been reading the anticonvulsants may decrease the effectiveness of rTMS according to Canadian guidance. I take 1800 mg gabapentin as one of my drugs. Is there any truth in this?

To answer your questions, whether you receive rTMS or not, your medication will have to be considered carefully. Most people having rTMS also take medication, unless they have decided to avoid tablets altogether. Many also have psychotherapy. Every component of a carefully considered treatment plan will have a synergistic action. In other words, other interventions may in fact help the chances of recovery with rTMS.

It is true to say that certain medications will be a better choice for a given individual than others, but this would apply in any case, even if you are not having rTMS.

As far as the maintenance is concerned, you are right, we often recommend something like one treatment every month or so, depending on personal circumstances, and this is often enough to keep you well.

Finally, no, I don't think the Gabapentin would be a significant obstacle.

Kind regards

Dr Rafael Euba

I am making this enquiry on behalf of someone who is taking multiple medication for severe depression.

Is it advisable to stop taking the medication before starting the rtms treatment? (I understand that the withdrawal symptoms are likely to be severe)

No, there is no need to stop the medication.

rTMS can be combined with medication and in fact most patients having rTMS also take tablets during the treatment.

Given that they suffer with severe symptoms of depression, their psychiatrist may still want to continue making adjustments to their medication in order to improve their chances of recovery while receiving rTMS.

Kind regards

Dr Rafael Euba
rTMS and ECT Consultant


I left a message a couple of days ago on the number shown for rTMS queries at The Woodlands Unit; as I haven't heard back I am emailing to ask if my GP refers me for rTMS on the NHS for treatment-resistant depression at your Unit ( and we live outside of your borough although still in Greater London), does my GP simply write a referral letter or do they have to apply for funding first?

Many thanks for your help

Hi Clare,

Thank you for your interest in our rTMS Service. If you live outside Bexley, Bromley or Greenwich boroughs, please discuss this treatment with your GP and/or local psychiatrist.

They can apply to your local CCG for funding and once this is in place they can make a referral to our service. If you have medical insurance which would cover this treatment this may also be an option.

One of our managers is going to contact you in case you have further questions.

Kind regards

Rachel Matheson
Service Manager for Mental Health
Greenwich Directorate

Please can you call to arrange assessment
I am private funding
I have a diagnosis of PTSD and depression after
Brain injury in 2015

I have been to the London psychiatry centre
However the logistics of attending everyday is
To challenging
I appreciate a call assp

Dear Christine

Thank you for enquiring about our rTMS service.

We understand that Jeck Ding has been in contact with you today.

Kind regards
Helen Jones

Associate Director, Mental Health
Bexley Care

Hello there,
I may have to cover the cost of TMS myself.
Can you please advise on the pricing of this treatment.
Kindest regards,


I would like to know the cost of rTMS treatment for depression. How many sessions would I need? is this funded by NHS?


Reply from Helen Jones 5/5 pm

Dear Imran

Thank you for enquiring about rTMS. We launched this service in January 2017 for patients with a diagnosis of treatment resistant depression.

This is a new treatment, included in the NICE guidelines in 2016, for both depression and migraine treatment. Each rTMS session takes about half an hour. The treatment is short but intense and you would be required to attend up to 5 sessions a week for an average of 3 to 6 weeks.

At this time, we are able to provide this treatment for people with depression who are under our Oxleas mental health services and therefore residents of Bexley, Bromley and Greenwich. We are also able to provide rTMS to patients out of borough who have funding in place (approved by a local CCG or referred from a Private Psychiatrist or medical insurance scheme).

Dr Euba or Jeck Ding would be happy to talk to you about this treatment in more detail and the cost and they can be contacted on: 020 3889 5168.

We have a leaflet that you can access on our website which will provide you with some information.

Kind regards

Helen Jones
Associate Director
Bexley Mental Health Services

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