Transcranial magnetic stimulation (TMS) is a non-invasive method of brain stimulation that is receiving increasingly attention for new clinical applications. Through electromagnetic induction cortical activity can be modulated and therapeutic effects can be achieved in a variety of psychiatric and neurological conditions. According to the World Health Organization (WHO) depression is the most disabling disease in the world and 350 million people suffer from depression globally. Major depression is the most common disorder to be treated with TMS and the first mental disorder for which TMS received approval from the US Food and Drug Administration (FDA). We here introduce the basic principles of TMS, discuss the latest data on safety and side effects, and present various TMS treatment protocols as well as treatment response predictors in major depressive disorder.

Transdermal fentanyl is an opioid analgesic that is effective on chronic pain, and which appears to be advantageous due to several factors such as ease of administration, the relatively stable serum concentration and long dose intervals. Nevertheless, the danger of abuse and dependence exists among patients who are prescribed fentanyl patches. We present a case of transdermal fentanyl abuse, where the administration route of the drug was changed. Our patient, who had no history of substance abuse and who suffered from chronic nonmalignant pain, used the fentanyl transdermal patches as oral transmucosal medication, raising the dose by ten-fold. This abuse of the drug was only for analgesic purposes without seeking anxiolysis and/or euphoria. After treatment and progressive reduction of fentanyl, the patient remains in good condition, and is currently taking the initial dose of the drug transdermally, without having experienced any withdrawal symptoms.

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