The Efficacy of Transcranial Magnetic Stimulation for Major Depression: A Review of the Evidence

Major depression is a leading cause of disease burden worldwide. Although various treatment approaches exist, including pharmacological (eg, antidepressant agents), psychotherapeutic (eg, cognitivebehavioral therapy), and neuromodulatory (eg, electroconvulsive therapy [ECT]), a substantial number of patients do not adequately bene!t from or cannot tolerate these existing options. This has led to a re-emergence of other neurostimulation strategies, the best studied to date being transcranial magnetic stimulation (TMS). This article reviews the rationale for TMS in treating depression with a brief description of the basic principles underlying magnetic stimulation; a discussion of its putative mechanism of action; and its recommended treatment parameters. We then focus on the evidence base to support its use as both a monotherapy and adjunctive therapy for the acute and maintenance treatment of major depression. These data came from controlled trials comparing TMS to a sham procedure and naturalistic outcome studies for acute depression; studies directly comparing TMS to ECT for major depression; and open-label studies, retrospective analyses, naturalistic outcome studies, and case reports that consider the durability of TMS’ e"ect after acute response. The results of these studies have led to a growing use of TMS in clinical practice for treatment-resistant depression. [Psychiatr Ann. 2014; 44(6):284–292.] Philip G. Janicak, MD, is Professor of Psychiatry, and Director, Transcranial Magnetic Stimulation Center, Rush University Medical Center. Linda Carpenter, MD, is Professor, Brown Department of Psychiatry and Human Behavior, and Chief, Butler Hospital Mood