A practical guide to the use of repetitive transcranial magnetic stimulation in the treatment of depression

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is currently emerging as a new treatment for patients with mood disorders. Research into the use of rTMS for the treatment of patients with depression has been conducted now for a period of greater than 15 years and a considerable body of knowledge has accumulated informing its use.ObjectiveThe aim of this paper was to review the use of various rTMS techniques for the treatment of depression and to provide practical suggestions to address the common issues encountered in the prescribing and administration of rTMS treatment.MethodsThese suggestions have been informed both by a review of the relevant literature and the experience of the authors in the treatment of many patients with depression with rTMS over a period of 10 years.Results and ConclusionsHigh-frequency rTMS applied to the left dorsolateral prefrontal cortex, using a set of parameters very similar to those originally described in the mid-1990s, is an effective treatment for patients with major depressive disorder. Other forms of stimulation, such as low-frequency stimulation applied to the right prefrontal cortex and bilateral approaches, may prove valuable but require evaluation in larger trials. Significant benefit appears likely to accumulate through the use of methods that involve a more reliable targeting of prefrontal brain regions. Suggestions are also made around the use of rTMS treatment as a maintenance therapy and in specific illness subgroups.