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


OBJECTIVE
The 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.


METHODS
These 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.


CONCLUSIONS
High-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.
Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia. Electronic address: paul.fitzgerald@monash.edu.
Paul B
PB
Fitzgerald
Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Zafiris J
ZJ
Daskalakis
D003863:Depression / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D009864:Ontario; D017410:Practice Guidelines as Topic; D050781:Transcranial Magnetic Stimulation / Q000379:methods* / Q000592:standards*