Transcranial magnetic stimulation achieved remission rates as high as 62% in treatment-resistant depression, according to a recent review.

A comprehensive consensus statement on Transcranial magnetic stimulation (TMS) for treating depression was published in Clinical Neurophysiology. Developed by the National Network of Depression Centers Neuromodulation Task Group and endorsed by the Clinical TMS Society and the International Federation of Clinical Neurophysiology, the review assessed TMS efficacy, safety, and clinical considerations for depressive disorders.

Key Findings and Recommendations:

Efficacy and Protocol Selection
The review reaffirmed the efficacy of high-frequency repetitive TMS (Hedge’s g = 0.79, 95% CI 0.61–0.98), based on 65 RCTs (n = 2,982 participants). Real-world data from 5,010 participants showed response rates of 58%-83% and remission rates of 28%-62%. Intermittent theta burst stimulation (iTBS) was identified as a time-efficient alternative with comparable efficacy to high-frequency rTMS (session duration: 3 minutes vs. 38 minutes).

Pre-Treatment Guidelines
Clinicians should conduct comprehensive evaluations to identify seizure risks, contraindications (e.g., ferromagnetic implants), and prior treatment history. Baseline motor thresholds must be assessed and periodically rechecked during the treatment course to ensure safety.

Standard Treatment and Maintenance Protocols
The consensus recommends completing the full treatment course (30–36 sessions) for optimal outcomes. Sustained response rates of 66.5% at 3 months and 46.3% at 12 months highlight the potential of maintenance TMS, though standardized schedules are still under development. Clustered maintenance schedules (e.g., five sessions over two days) are promising.

Advanced Targeting Methods
MRI-guided neuronavigation and individualized targeting methods are emerging as potential tools to enhance treatment precision. While promising, these methods require further research to establish widespread clinical utility.

Special Populations

• Adolescents (FDA-cleared for ages 15+): Use caution, noting higher placebo responses in this group.
• Perinatal Patients: Safe but under-researched; offers an alternative to contraindicated medications.
• Geriatric Patients: Lower stimulation intensities may be needed due to cortical atrophy.

Safety Profile
Common adverse effects include scalp discomfort (39%) and headaches (28%-65%). Seizures are rare (<0.1%). Pre-treatment safety checks and close monitoring during sessions are critical.

Barriers and Ethical Considerations
Barriers such as cost, access, and lack of trained providers remain significant. The consensus stresses improving provider education and advocating for insurance coverage. Ethical concerns include limited diversity in the data and access disparities in low-resource settings.

Documentation Standards
Clinicians should maintain detailed records, including baseline assessments, treatment protocols, and post-treatment progress. The use of mood rating scales is recommended to monitor clinical outcomes.

The full disclosures and detailed recommendations are available in the published statement.