Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression

Abstract

Multiple randomized controlled trials and published literature have supported the safety and efficacy of rTMS antidepressant therapy. These consensus recommendations, developed by the NNDC rTMS Task Group and APA CoR Task Force on Novel Biomarkers and Treatments, provide comprehensive information for the safe and effective clinical application of rTMS in the treatment of MDD.

Repetitive transcranial magnetic stimulation for chronic neuropathic pain in patients with bladder pain syndrome/interstitial cystitis

“…The clinical improvement perceived by our patients was not due to a reduction in the depressive component, as is confirmed by the fact that the BDI score did not change significantly during the study. The BDI was analyzed because rTMS is also used as a safe and effective clinical application in the treatment of major depressive disorder …”

Dr McClintock and Colleagues Reply

“…1 It is auspicious that this set of consensus recommendations comports highly with our own society's consensus recommendations published in 2016. 2 The high degree of concordance between them is an indication that the clinical practice of treating depression with rTMS has matured significantly since the first FDA clearance of a TMS device for major depression in 2008 and signals that the basic features of a standard of care has emerged for this modality of depression treatment.…”

“…1 They raised 3 main points about our consensus recommendations, focused on physical examination, qualifications of the TMS clinician, and qualifications of the TMS operator.…”

An Update on Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder

“…The central hypothesis behind the mechanism of action in rTMS is that it can modulate the activity of dysfunctional cortical regions that are stimulated and other brain regions functionally connected to the stimulation site . The neurophysiological effects of rTMS are, in part, mediated by the parameters of stimulation, including intensity relative to the motor threshold (MT), frequency, pattern of stimulation, coil type, and orientation, as well as the cortical region targeted . Although the ability to manipulate multiple parameters creates a tremendous opportunity for innovation, it also poses challenges regarding understanding variability in response to the treatment.…”