Is it time to introduce repetitive transcranial magnetic stimulation into standard clinical practice for the treatment of depressive disorders?
OBJECTIVE
To examine issues relating to the potential introduction of repetitive transcranial magnetic stimulation (rTMS) into clinical practice as a treatment for depression.


METHODS
A review of the outcomes literature accompanied by an analysis of issues relating to the potential advantages and pitfalls of the introduction of rTMS as a treatment strategy.


RESULTS
Evidence is progressively accumulating that rTMS has antidepressant properties that are clinically relevant. These effects are biologically plausible and supported by basic research. Patients with therapy-resistant depression have few treatment alternatives and experience significant suffering, thus justifying the early introduction of a new treatment such as rTMS for this patient group. However, this must be balanced by a need to foster considerable further research and not to raise expectations unreasonably.


CONCLUSIONS
It is timely for rTMS to be made more available to patients with treatment-resistant mood disorders. This need not be limited to clinical research trials but should only occur in medical settings where continual evaluation and research is conducted.
Fitzgerald
Paul
P
Alfred Psychiatry Research Centre, The Alfred and Monash University Department of Psychological Medicine, Prahan, Victoria, Australia. paul.fitzgerald@med.monash.edu.au
D000293:Adolescent; D000328:Adult; D003866:Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000295:instrumentation*; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology; D012886:Skull; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects* / Q000295:instrumentation*