What the Non-Psychiatrist Should Know About Transcranial Magnetic Stimulation for Major Depression.

Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation treatment for major depressive disorder. Randomized controlled trials show response rates twice times higher for TMS (23.9%) than placebo (12.3%) in adults with depression. Real world studies showed increased response rates up to 58% in clinically heterogenous adult patient populations. TMS is safe and well tolerated with a benign side effect profile and high adherence. Standard TMS protocols include left dorso-lateral prefrontal cortex stimulation using a fixed stimulation protocol or burst-patterned protocols such as intermittent theta burst delivered over six weeks. Novel accelerated protocols using high daily dosing and functional MRI targeting provide increased precision and improved treatment outcomes. TMS shows effectiveness in patients with comorbid anxiety, older adults and adolescents for which received FDA approval in 2024. Future studies incorporating neuroimaging techniques may help to refine protocols leading to improved outcomes across different patient populations.