title: The expanding evidence base for rTMS treatment of depression.
abstract: OBJECTIVE
  Daily left prefrontal transcranial magnetic stimulation (TMS) for several weeks was first proposed as an acute treatment for depression in the early 1990s, and was Food and Drug Administration (FDA) approved in 2008. In the past year, several important studies have been published that extend our understanding of this novel treatment approach.
  
  
  RESULTS
  The first round of multisite clinical trials with TMS addressed whether prefrontal rTMS has efficacy and were conducted in carefully selected depressed patients who were antidepressant medication free. Several more recent studies assess the clinical effectiveness of TMS and report that about 35-40% of real-world patients who are commonly taking adjunctive antidepressants reach remission with a modest side effect profile. There are also new studies examining the durability of the TMS-induced antidepressant effect. Fifty-eight percent of TMS remitters remain remitted at 3-month follow-up.
  
  
  CONCLUSIONS
  These recent studies suggest that daily left prefrontal TMS over several weeks as a treatment for depression not only appears to have efficacy in rigorous randomized controlled trials, but is effective in real-world settings, with remission in 30-40% of patients. The TMS antidepressant effect, once achieved, appears to be as durable as with other antidepressant medications or interventions. Much more research is needed, particularly with issues such as the TMS coil location, stimulation intensity and frequency, and dosing strategy.
authors.affiliation: Psychiatry Department, Brain Stimulation Laboratory, Medical University of South Carolina, and Ralph H. Johnson VA Medical Center, Charleston, South Carolina 29425, USA. georgem@musc.edu
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Taylor
authors.forename: E Baron
authors.initials: EB
authors.lastname: Short
mesh_terms: D003866:Depressive Disorder / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D017397:Prefrontal Cortex; D016032:Randomized Controlled Trials as Topic; D050781:Transcranial Magnetic Stimulation / Q000379:methods*