The expanding evidence base for rTMS treatment of depression

Abstract

Purpose of review Daily left prefrontal transcranial magnetic stimulation (TMS) for several weeks was first proposed as an acute treatment for depression in the early 1990’s, and was FDA approved in 2008. In the past year several important studies have been published that extend our understanding of this novel treatment approach. Recent findings 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. 58% of TMS remitters remain remitted at 3-month follow-up. Summary These recent studies suggest that daily left prefrontal TMS over several weeks as a treatment for depression appears to not only 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, particular with issues such as the TMS coil location, stimulation intensity and frequency, and dosing strategy.

Left Prefrontal Repetitive Transcranial Magnetic Stimulation in a Logopenic Variant of Primary Progressive Aphasia: A Case Report

“…The changes observed in cognitive and language functions were not related to mood changes because our patient had no mood disorders before or after hf-rTMS [33] . One of the major limitations of our study is that no sham rTMS was used to exclude placebo effect in this feasibility study.…”

Water diffusion reveals networks that modulate multiregional morphological plasticity after repetitive brain stimulation

“…In humans, repetitive transcranial magnetic stimulation (rTMS) alters cortical excitability at the stimulated site that outlasts the end of the stimulation, analogous to LTP or LTD in animal models (5,6), but also affects remote regions, possibly through transsynaptic pathways (7,8). Although rTMS has been proposed as a potential treatment for neurological and psychiatric disorders (9,10) and as a method to facilitate learning (11), the neural substrates underlying the effects of rTMS on remote regions of the brain remain poorly understood.…”

Contemporary Principles of Magnetotherapy Application in Physical Medicine and Rehabilitation // Savremeni principi primjene magnetoterapije u fizikalnoj medicini i rehabilitaciji

“…Repetitive transcranial magnetic stimulation in patients with Parkinson's disease leads to mild and moderate improvement of motor functions and it has a potential to be used as an additional therapy to treat Parkinson's disease. Future large studies should be projected to isolate specifi c clinical characteristics of Parkinson's disease that respond well to therapy rTMS (Mark, George et al, 2013). Since 2011 the FDA has been recommending TMS for treating depression.…”