Consensus review and considerations on TMS to treat depression: A comprehensive update endorsed by the National Network of Depression Centers, the Clinical TMS Society, and the International Federation of Clinical Neurophysiology
Nicholas T. Trapp, Anthony Purgianto, Joseph J. Taylor, Manpreet K. Singh, Lindsay M. Oberman, Brian J. Mickey, Nagy A. Youssef, Daniela Solzbacher, Benjamin Zebley, Laura Y. Cabrera, Susan K. Conroy, Mario A. Cristancho, Jackson R. Richards, Michael Flood, Tracy Barbour, Daniel M. Blumberger, Stephan F. Taylor, David Feifel, Irving M. Reti, Shawn M. McClintock, Sarah H. Lisanby, Mustafa M. Husain
Abstract
• Repetitive transcranial magnetic stimulation (rTMS) is a safe and effective treatment for depressive disorders. • New forms of rTMS such as intermittent theta burst (iTBS) are non-inferior to standard rTMS for treating depression. • Attempts to enhance efficacy (accelerated iTBS, MRI guidance, neuroplasticity modulators) show promising early findings. This article updates the prior 2018 consensus statement by the National Network of Depression Centers (NNDC) on the use of transcranial magnetic stimulation (TMS) in the treatment of depression, incorporating recent research and clinical developments. Publications on TMS and depression between September 2016 and April 2024 were identified using methods informed by PRISMA guidelines. The NNDC Neuromodulation Work Group met monthly between October 2022 and April 2024 to define important clinical topics and review pertinent literature. A modified Delphi method was used to achieve consensus. 2,396 abstracts and manuscripts met inclusion criteria for review. The work group generated consensus statements which include an updated narrative review of TMS safety, efficacy, and clinical features of use for depression. Considerations related to training, roles/responsibilities of providers, and documentation are also discussed. TMS continues to demonstrate broad evidence for safety and efficacy in treating depression. Newer forms of TMS are faster and potentially more effective than conventional repetitive TMS. Further exploration of targeting methods, use in special populations, and accelerated protocols is encouraged. This article provides an updated overview of topics relevant to the administration of TMS for depression and summarizes expert, consensus opinion on the practice of TMS in the United States.