An update on the clinical use of repetitive transcranial magnetic stimulation in the treatment of depression

• Published in: Journal of affective disorders Vol. 276; pp. 90 - 103
• Main Author: Fitzgerald, Paul B.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2020
• Subjects: Antidepressant; Antidepressive Agents - therapeutic use; Bipolar Disorder - drug therapy; Depression; Depressive Disorder, Major - drug therapy; Humans; Prefrontal Cortex; Remission; Repetitive transcranial magnetic stimulation; Response; Transcranial Magnetic Stimulation; Treatment Outcome; Response; Antidepressant; Depression; Remission; Repetitive transcranial magnetic stimulation
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2020.06.067

•rTMS is an effective treatment for depression that is mostly well tolerated and safe.•There are multiple forms of rTMS with established efficacy but no form appears superior to the others.•rTMS is effective in patients with various levels of treatment resistance.•Clinical rTMS practice is evolving in terms of treatment paradigms, targeting and scheduling. Repetitive transcranial magnetic stimulation (rTMS) is an increasingly used treatment for patients with depression. The use of rTMS in depression is supported by over 20 years of clinical trials. There has been a significant increase in knowledge around the use of rTMS in recent years. The aim of this paper was to review the use of rTMS in depression to provide an update for rTMS practitioners and clinicians interested in the clinical use of this treatment. A targeted review of the literature around the use of rTMS treatment of depression with a specific focus on studies published in the last 3 years. High-frequency rTMS applied to the left dorsolateral prefrontal cortex is an effective treatment for acute episodes of major depressive disorder. There are several additional methods of rTMS delivery that are supported by clinical trials and meta-analyses but no substantive evidence that any one approach is any more effective than any other. rTMS is effective in unipolar depression and most likely bipolar depression. rTMS courses may be repeated in the management of depressive relapse but there is less evidence for the use of rTMS in the maintenance phase. The science around the use of rTMS is rapidly evolving and there is a considerable need for practitioners to remain abreast of the current state of this literature and its implications for clinical practice. rTMS is an effective antidepressant treatment but its optimal use should be continually informed by knowledge of the state of the art.