Transcranial magnetic stimulation in the treatment of depression.
OBJECTIVE
Transcranial magnetic stimulation (TMS) is a noninvasive and easily tolerated method of altering cortical physiology. The authors evaluate evidence from the last decade supporting a possible role for TMS in the treatment of depression and explore clinical and technical considerations that might bear on treatment success.


METHODS
The authors review English-language controlled studies of nonconvulsive TMS therapy for depression that appeared in the MEDLINE database through early 2002, as well as one study that was in press in 2002 and was published in 2003. In addition, the authors discuss studies that have examined technical, methodological, and clinical treatment parameters of TMS.


RESULTS
Most data support an antidepressant effect of high-frequency repetitive TMS administered to the left prefrontal cortex. The absence of psychosis, younger age, and certain brain physiologic markers might predict treatment success. Technical parameters possibly affecting treatment success include intensity and duration of treatment, but these suggestions require systematic testing.


CONCLUSIONS
TMS shows promise as a novel antidepressant treatment. Systematic and large-scale studies are needed to identify patient populations most likely to benefit and treatment parameters most likely to produce success. In addition to its potential clinical role, TMS promises to provide insights into the pathophysiology of depression through research designs in which the ability of TMS to alter brain activity is coupled with functional neuroimaging.
Psychiatry Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Ari A
AA
Gershon
Pinhas N
PN
Dannon
Leon
L
Grunhaus
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002540:Cerebral Cortex / Q000502:physiology* / Q000503:physiopathology*; D003131:Combined Modality Therapy; D018849:Controlled Clinical Trials as Topic; D003866:Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D055590:Electromagnetic Phenomena / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation / Q000627:therapeutic use*; D016896:Treatment Outcome
D000928:Antidepressive Agents