Depression
You feel constantly down, have little energy, or notice that things you used to enjoy barely affect you anymore. Even simple daily activities can feel overwhelming. Perhaps you have already tried various treatments, but the symptoms keep returning or the improvement is not lasting.
Depression is a mental health condition in which a persistent low mood and/or loss of interest or pleasure are accompanied by other symptoms, such as fatigue, sleep problems, difficulty concentrating, and impaired daily functioning.
Scientific research shows that depression can be associated with changes in brain networks involved in mood, motivation, emotional processing, and cognitive control.
At BRAI3N, we combine neuroscience expertise with a personalized approach.
We investigate which factors and brain processes may be involved in your symptoms and whether neuromodulation is an appropriate treatment for you.
What is it?
What is depression?
Everyone feels sad, tired, or less motivated at times. Usually, these feelings change over time.
With depression, the symptoms persist longer and have a much stronger impact on daily life. Activities that used to be second nature can suddenly require a lot of effort. Connecting with others becomes more difficult, and positive experiences sometimes provide little to no satisfaction.
A depressive episode is generally considered when a low mood and/or a clear loss of interest or pleasure is present for at least two weeks, along with other symptoms that affect functioning.
Common symptoms include:
- Persistent sadness, emptiness, or loss of pleasure.
- Fatigue and a lack of energy.
- Concentration problems, forgetfulness, or difficulty making decisions.
- Sleep problems or, conversely, sleeping much more than usual.
- Changes in appetite or weight.
- Feelings of worthlessness, guilt, or hopelessness.
- Restlessness or, conversely, a noticeable slowing of thought and movement.
For some people, sadness and gloom are at the forefront. Others primarily experience an emotional emptiness, a loss of motivation, or the feeling of being unable to enjoy anything anymore.
Not everyone experiences the same symptoms. The severity, duration, and combination of symptoms vary from person to person.
What happens in the brain during depression?
Depression is more than just a temporary change in mood.
Our emotions, motivation, attention, and ability to experience pleasure arise from the interaction between various brain regions.
In scientific research, changes in the activity and communication of certain brain networks are observed in people with depression.
Three networks are particularly relevant here:
1. The emotional network
Brain regions such as the amygdala and the anterior cingulate cortex play an important role in processing and regulating emotions.
In depression, the functioning of these networks can change, causing negative experiences to receive more attention and making it more difficult to regulate emotions.
2. The cognitive control network
The prefrontal cortex is involved in attention, planning, decision-making, and the regulation of thoughts and emotions.
Changes in this network can contribute to concentration problems, mental sluggishness, and difficulty letting go of negative thoughts.
3. The motivation and reward network
This network helps us experience motivation and pleasure.
When these processes function differently, it can become harder to feel interest, satisfaction, or enthusiasm. This is also known as anhedonia.
Why are brain networks important for treatment?
Scientific research shows that the brain regions involved do not function in isolation, but are constantly communicating with each other.
The connections between the prefrontal cortex and deeper structures, such as the anterior cingulate cortex, are particularly important for regulating mood and emotions.
These insights form an important scientific basis for neuromodulation.
By specifically influencing the activity of certain brain regions, the associated networks can also be modulated.
Brain changes are not the same for everyone. Furthermore, depression arises from an interplay of biological, psychological, and social factors.
How to treat
Scientifically supported treatment for depression
Psychotherapy and antidepressant medication are important treatments for depression. Many people experience a clear improvement with these.
However, there are patients for whom symptoms do not decrease sufficiently, return, or for whom medication is difficult to tolerate.
For these patients, neuromodulation can be a valuable treatment option.
Transcranial Magnetic Stimulation (TMS) for depression
TMS is a non-invasive form of neuromodulation in which magnetic pulses are administered via a coil placed against the head.
These pulses generate small electrical currents in the brain, thereby influencing the activity of brain regions involved in mood and emotion regulation.
The treatment is performed without surgery, implants, or general anesthesia. You remain awake during the stimulation.
How can TMS help with depression?
In the treatment of depression, the dorsolateral prefrontal cortex is often stimulated. This brain region plays an important role in cognitive control and the regulation of emotions.
By stimulating this region, TMS can also influence functionally connected brain networks, including networks in which the anterior cingulate cortex plays an important role.
The goal is to favorably influence the activity and cooperation of brain networks involved in depressive symptoms.
Large-scale clinical studies and international guidelines support the efficacy of repetitive TMS (rTMS), especially for depression that does not respond sufficiently to previous treatments.
Not every patient responds in the same way, but for a portion of patients, a meaningful reduction in depressive symptoms can be achieved.
Different forms of TMS
Within neuromodulation, there are various stimulation techniques and treatment protocols.
Repetitive TMS (rTMS)
With rTMS, magnetic pulses are repeatedly delivered to specific areas of the brain. Depending on the chosen protocol, different stimulation frequencies can be used.
This is one of the best-researched non-invasive neuromodulation techniques for depression.
Theta-burst stimulation (TBS)
Theta-burst stimulation is a form of TMS in which magnetic pulses are delivered in short, rapidly successive bursts.
With intermittent theta-burst stimulation (iTBS), the stimulation portion of a session can be significantly shorter than with traditional rTMS.
Large clinical studies and meta-analyses support iTBS as an effective treatment option for depression.
Stimulation of deeper brain networks
Other coil shapes and stimulation targets are also being researched, including techniques that aim to influence the activity of the anterior cingulate cortex.
BRAI3N researchers Sven Vanneste, Jan Ost, and Dirk De Ridder published scientific research as early as 2014 on TMS using a double-cone coil for treatment-resistant chronic depression.
This publication is part of BRAI3N's research history. It was a case study and therefore does not serve as independent proof of the efficacy of this specific protocol.
Is TMS for depression covered by insurance?
Internationally, TMS is becoming increasingly established as a treatment for depression.
In the Netherlands, rTMS for treatment-resistant depression has been recognized by health insurers as evidence-based care since 2017. Within the Dutch mental healthcare system, the treatment may be covered by basic insurance, depending on the medical indication, the healthcare provider, and insurance terms.
In other European countries, rTMS is also offered and reimbursed within certain public healthcare systems, for example, through selected NHS services in England.
However, recognition and reimbursement vary significantly by country and healthcare system.
Reimbursement abroad does not automatically mean that a TMS treatment at BRAI3N in Belgium will be covered.
Costs and potential reimbursement options can be discussed during the practical preparation for a treatment plan.
Transcranial electrical stimulation (tES) for depression
In addition to transcranial magnetic stimulation (TMS), transcranial electrical stimulation (tES) offers possibilities for targeted influence on brain networks involved in mood, motivation, and emotion regulation.
This non-invasive neuromodulation technique involves delivering a weak electrical current via electrodes placed on the head. Depending on the type of stimulation used, this can influence the activity of specific brain regions.
There are various forms of electrical stimulation, including transcranial direct current stimulation (tDCS), alternating current stimulation (tACS), and transcranial random noise stimulation (tRNS).
Increasing scientific research shows that certain forms of tEScan contribute to a reduction in depressive symptoms.
A large-scale systematic review and meta-analysis from 2025, based on 88 randomized clinical trials with more than 5,500 participants, found beneficial effects of electrical stimulation across various patient groups.
In particular, tDCS in combination with antidepressant medication and certain forms of tACS showed positive results. However, efficacy varies depending on the stimulation technique, treatment protocol, and patient group.
These findings support the further development of targeted electrical neuromodulation as an adjunctive treatment option for depression.
At BRAI3N, we determine which form of neuromodulation best aligns with your symptoms, previous treatments, and medical history. In doing so, we take into account the available scientific evidence and your individual treatment goals.
What does the treatment process at BRAI3N look like?
Every depression follows its own course. That is why we start with a thorough assessment of your symptoms, medical history, and previous treatments.
Our treatment process can consist of four phases.
1. Assessment
We examine your depressive symptoms, their impact on your daily functioning, and which treatments you have previously undergone.
Where appropriate, a qEEG measurement and analysis can provide additional information about electrical brain activity. A qEEG cannot independently diagnose depression or reliably predict which TMS protocol will work best for you.
2. Targeted treatment
Based on the clinical assessment, we determine whether TMS is a suitable treatment option.
When neuromodulation is considered, we discuss the stimulation protocol, the expected course of treatment, and potential side effects.
TMS can be part of a broader treatment plan that also includes psychotherapy and/or medication.
3. Stabilization
Throughout the treatment process, we monitor how your symptoms evolve.
We focus on mood, motivation, sleep, concentration, and daily functioning. Using clinical evaluations, we assess how you are responding to the treatment and whether further adjustments are necessary.
4. Maintenance
When symptoms improve, we work together to determine how to best support this progress.
Depending on your situation, psychological counseling, medication, follow-up care, or sometimes additional TMS sessions may be considered.
Not everyone requires the same treatment or follow-up plan.
Contact us for a no-obligation consultation or to schedule an appointment
Scientific Background
BRAI3N’s neuroscientific approach is based on international scientific literature regarding depression, brain networks, and neuromodulation.
Researchers involved with BRAI3N have contributed to publications on the brain mechanisms of depression and the possibilities of targeted brain stimulation.
The selection below combines our own research with independent scientific reviews and clinical studies.
TMS by Double-Cone Coil Prefrontal Stimulation for Medication Resistant Chronic Depression: A Case Report
Vanneste S, Ost J, Langguth B, De Ridder D. TMS by double-cone coil prefrontal stimulation for medication resistant chronic depression: a case report.Neurocase. 2014;20(1):61–68.
Read the publication in Neurocase
Theta Burst Stimulation for Depression: A Systematic Review and Network and Pairwise Meta-Analysis
Kishi T, Ikuta T, Sakuma K, Hatano M, Matsuda Y, Wilkening J, et al. Theta burst stimulation for depression: a systematic review and network and pairwise meta-analysis.Molecular Psychiatry. 2024;29:3893–3899.
Read the publication in Molecular Psychiatry
Advances in Transcranial Magnetic Stimulation (TMS) and Its Applications in Resistant Depression
Koutsomitros T, Evagorou O, Schuhmann T, Zamar A, Sack AT. Advances in transcranial magnetic stimulation (TMS) and its applications in resistant depression.Psychiatriki. 2021;32(Suppl 1)–S98.
Read the publication in Psychiatriki
Neuromodulation for Treatment-Resistant Depression: Functional Network Targets Contributing to Antidepressive Outcomes
Idlett-Ali SL, Salazar CA, Bell MS, Short EB, Rowland NC. Neuromodulation for treatment-resistant depression: functional network targets contributing to antidepressive outcomes.Frontiers in Human Neuroscience. 2023;17:1125074.
Read the publication in Frontiers in Human Neuroscience
Neuronal Correlates of Depression
Chaudhury D, Liu H, Han MH. Neuronal correlates of depression.Cellular and Molecular Life Sciences. 2015;72(24):4825–4848.
Read the publication in Cellular and Molecular Life Sciences
Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Treatment-Resistant Depression: Possibilities, Limits and Future Perspectives
De Ridder D, Vanneste S, Langguth B. Deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression: possibilities, limits and future perspectives.Annals of Translational Medicine. 2017;5(7):167.
Read the publication in Annals of Translational Medicine
Which Tinnitus-Related Aspects Are Relevant for Quality of Life and Depression: Results From a Large International Multicentre Sample
Zeman F, Koller M, Langguth B, Landgrebe M, et al. Which tinnitus-related aspects are relevant for quality of life and depression: results from a large international multicentre sample.Health and Quality of Life Outcomes. 2014;12:7.
Read the publication in Health and Quality of Life Outcomes
Transcranial Electrical Stimulation in Treatment of Depression: A Systematic Review and Meta-Analysis
Ren C, Pagali SR, Wang Z, Kung S, Boyapati RB, Islam K, et al. Transcranial electrical stimulation in treatment of depression: a systematic review and meta-analysis. JAMA Network Open. 2025;8(6).
Lees de publicatie in JAMA Network Open
Authors: Prof. Dr. Sven Vanneste,Prof. Dr. Dirk De RidderandJan Ost- 09/10/2026
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