Neuromodulation as the third pillar of mental healthcare

I. A crisis that can no longer be ignored

The figures are sobering. According to the RIZIV, the number of Belgians under 34 who have been out of work for more than a year due to depression or burnout has risen by sixty percent over the past five years. Measured more broadly, the prevalence of depression and burnout in Belgium increased by 44 percent between 2018 and 2023. This trend is not isolated: the Global Burden of Disease Study 2023, published in The Lancet, estimates that 1.17 billion people worldwide are struggling with a mental disorder, an increase of more than 95 percent compared to 1990.
Remarkably, the increase is strongest in the wealthiest countries. Prosperity evidently offers no protection.
Mental health conditions are now the fifth leading cause of Disability-Adjusted Life Years (DALYs) worldwide and the absolute primary cause of years lived with a disability. The burden of disease affects women more heavily than men and peaks among young people between 15 and 19 years old—the very generation that must carry the future.
In the article, the scientists call for action: stronger surveillance systems, more inclusive policies, and earlier treatment. The conclusion is unequivocal: addressing the mental health crisis is not a choice, but an obligation.

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II. The existing pillars and their limits

Mental healthcare currently rests on two pillars: medication and psychotherapy. Both are indispensable and well-supported. Antidepressants, from classic SSRIs and SNRIs to newer agents like esketamine, alleviate real suffering for many patients. Psychotherapy offers an equally diverse arsenal: cognitive behavioral therapy, EMDR, schema therapy, mindfulness, and dozens of other methods are firmly rooted in clinical practice.
Yet, these two pillars together are not enough to address the full scale of the crisis.
A substantial group of patients does not respond sufficiently to medication, psychotherapy, or a combination of both. Treatment-resistant depression, chronic pain, tinnitus, fibromyalgia, burnout, neurodegenerative disorders, … form a persistent group for whom the existing offerings fall short.
This clinical frustration is further sharpened by the fact that large pharmaceutical companies have largely withdrawn their investments in research into new medications that affect the nervous system.

The need for an innovative response is therefore urgent and real.

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III. Neuromodulation: the operating principle

Neuromodulation starts from one of the most fascinating properties of the human nervous system: neuroplasticity. The brain is not a static organ. It is constantly in motion; it learns, recovers, creates new connections, and prunes unused pathways. Neuromodulation leverages this property by using targeted electrical or magnetic impulses, conditioning-based neurofeedback, or focused ultrasound to influence, strengthen, inhibit, or recalibrate neural organization.
The scientific foundation is multi-layered. It includes insights from the Bayesian brain theory, in which pathological states are understood as disrupted inference processes where dysregulated communication between brain regions and networks underlies symptoms such as depression, anxiety, tinnitus, or chronic pain.

It takes into account the "Triple Network Model." It is the interaction between the salience network, the default mode network, and the executive network that determines how experiences are perceived as threatening and how attention is directed.  
It integrates insights into neuro-inflammatory processes without overlooking genetic vulnerability.

In short, neuromodulation is not an intuitive intervention, but a scientifically grounded approach deeply anchored in contemporary neuroscience.

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IV. Why neuromodulation deserves to be the third pillar

The power of neuromodulation as a complement to existing pillars lies in the interplay of several unique characteristics.
The techniques are non-invasive. No surgical procedures are required, and there are no substances that burden the metabolism. Side effects are limited to mild, transient complaints such as slight fatigue, a lightheaded feeling, or a temporary headache.
This makes neuromodulation suitable as an add-on therapy—a complementary approach alongside medication and psychotherapy, rather than a replacement for either.

Furthermore, neuromodulation offers a crucial asset that cannot be underestimated in an overburdened healthcare system: scalability. A single practitioner can supervise multiple patients simultaneously. In a sector straining under a shortage of manpower and resources, this is not a marginal consideration; it is a strategic advantage.
Today, neuromodulation primarily reaches patients for whom other treatments have failed. That is valuable, but it is not ambitious enough.
The technique is not just a lifeline for treatment-resistant cases; it is a full-fledged complement to medication and psychotherapy that can be deployed much earlier in the treatment trajectory.

Early intervention is not a luxury; it is the most effective strategy to prevent chronicity. The faster a patient stabilizes, the lower the chance that symptoms become entrenched in neurobiology and behavior. Neuromodulation offers that perspective, not as a last resort, but as an intelligent addition to existing treatment options.
The fact that neuromodulation deserves a place alongside medication and psychotherapy is no longer a theoretical hypothesis, but a conclusion increasingly supported by scientific research.

For Transcranial Magnetic Stimulation (TMS), the evidence is most compelling in major depression. Meta-analyses and international guidelines confirm that repetitive TMS is an effective treatment for patients who respond insufficiently to antidepressants. Moreover, the combination of TMS and medication has been shown to further increase the likelihood of recovery. Significant improvements in depressive symptoms and suicidal ideation are now also being observed in adolescents.
However, the relevance of TMS extends beyond depression alone. Research shows that the technique can also be a valuable addition for schizophrenia, post-traumatic stress disorder, migraine, neuropathic pain, and Tourette syndrome.
In addition, meta-analyses point to improvements in cognitive functions such as attention and working memory across various neurological and psychiatric conditions, including dementia and mild cognitive impairment.

Scientific and societal recognition is also growing for transcranial direct current stimulation (tDCS). In 2026, the US FDA gave the green light to tDCS for patients with moderate to severe depression. That is more than a symbolic decision; it reflects a growing confidence in the safety, efficacy, and scalability of non-invasive neuromodulation.
When a treatment is deemed safe enough to be applied under medical supervision, it underscores how far the field has developed.

Perhaps even more important is what these results illustrate collectively. Neuromodulation does not target one specific disease, but rather the underlying functioning of brain networks. This creates a transdiagnostic approach where the same technology can contribute to the recovery of various conditions traditionally viewed as separate clinical entities.
At the same time, neuromodulation has proven to be a safe method; serious side effects are extremely rare, while the treatment remains non-invasive and can be deployed in a scalable manner within a healthcare system that is increasingly under pressure.

In an era where the development of new psychiatric medication is slowing down, neuromodulation represents not only a therapeutic innovation but also a necessary strategic expansion of the existing care arsenal.

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V. Honesty about the limitations

Advocating for neuromodulation requires honesty. Neuromodulation is not a miracle cure. Just like medication and psychotherapy, it does not work for everyone. The effect varies per person, per diagnosis, and per technique.
The equipment is expensive. In Belgium, there is currently no reimbursement scheme, which limits accessibility. The Netherlands is ahead: TMS is already reimbursed there for treatment-resistant depression.

The fact that Belgium is lagging behind is a policy choice that deserves to be reconsidered. As early as 2018, the Superior Health Council gave the green light to the Ministry of Public Health to recognize Transcranial Magnetic Stimulation (TMS) for depression. A missed opportunity...
But perhaps the biggest hurdle is the knowledge required to use neuromodulation responsibly.
Correctly interpreting clinical symptoms, a quantitative EEG, and associated psychometric data requires a level of specialization that most healthcare providers do not currently possess.
Applying neuromodulation without that knowledge is not just ineffective; it is potentially harmful. The training of qualified practitioners and the development of specialized centers are therefore not secondary issues, but essential prerequisites.

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VI. No luxury of future research

Some voices call for caution: let the research mature further, wait for broader recognition, avoid premature use. That caution is understandable, but we no longer have that luxury. The need for care is now. The waiting lists are now. The people sitting at home with treatment-resistant depression, anxiety, chronic pain, severe tinnitus, or burnout are waiting now.
Neuromodulation is no longer in its infancy. The scientific foundation is there. The clinical results are promising. Technological development is moving fast. It is time to take the step from the laboratory to clinical reality, and from experiment to policy.

That does not mean that further research is unnecessary. On the contrary: continuous research is essential to monitor quality and deepen knowledge.

But research and clinical application are not mutually exclusive. They reinforce each other.
And that is precisely why it is necessary to focus on a short chain between scientists and clinicians.
The continuous cross-pollination between both entities contributes to a better understanding of how the brain works and how neuromodulation influences this process.

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Conclusion

Mental healthcare is facing a challenge of historic proportions. Demand is growing, supply is not keeping up, and the two existing pillars, however valuable, can no longer bridge that gap alone.
Neuromodulation offers a scientifically grounded, non-invasive, and scalable answer that can complement and strengthen existing care.
The path forward requires investment: in training, in infrastructure, and in policy. It requires the courage to act based on existing evidence, without waiting for the absolute certainty that never exists in medicine anyway.

The question is no longer whether neuromodulation deserves a place in mental healthcare. The question is how many more patients we will keep waiting before we actually give it that place.

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Jan Ost, June 2026

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