Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression

Abstract

Objective: To provide expert recommendations for the safe and effective application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder (MDD). Participants: Participants included a group of 17 expert clinicians and researchers with expertise in the clinical application of rTMS, representing the National Network of Depression Centers (NNDC) rTMS Task Group and members of the American Psychiatric Association Council of Research (APA COR) Task Force on Novel Biomarkers and Treatments. Evidence: The consensus statement is based on a review of extensive literature of two databases searched between the years 1990 – 2016. The search terms included variants of major depressive disorder and transcranial magnetic stimulation. The results were limited to English language and that focused on adult populations, and generated approximately 1,500 retrieved studies. A total of 118 publications were included in the consensus statement, and were supplemented with expert opinion to achieve consensus recommendations on key issues surrounding the administration of rTMS for MDD in clinical practice settings. Consensus Process: In cases where the research evidence was equivocal or unclear, a consensus decision on how rTMS should be administered was reached by the authors of this paper and is denoted in the paper as “expert opinion.” Conclusions: Multiple randomized controlled trials and published literature have supported the safety and efficacy of rTMS antidepressant therapy. These consensus recommendations, developed by the NNDC Task Group and APA COR, provide comprehensive information for the safe and effective clinical application or rTMS in the treatment of MDD.