The Clinical TMS Society Consensus Review and Treatment Recommendations for TMS Therapy for Major Depressive Disorder
Open accessAbstract
BACKGROUND: Prefrontal Transcranial Magnetic Stimulation (TMS) therapy repeated daily over 4-6 weeks (20-30 sessions) is US Food and Drug Administration (FDA) approved for treating Major Depressive Disorder in adults who have not responded to prior antidepressant medications. In 2011, leading TMS clinical providers and researchers created the Clinical TMS Society (cTMSs) (www.clinicaltmssociety.org, Greenwich, CT, USA), incorporated in 2013. METHODS: This consensus review was written by cTMSs leaders, informed by membership polls, and approved by the governing board. It summarizes current evidence for the safety and efficacy of the use of TMS therapy for treating depression in routine clinical practice. Authors systematically reviewed the published TMS antidepressant therapy clinical trials. Studies were then assessed and graded on their strength of evidence using the Levels of Evidence framework published by the University of Oxford Centre for Evidence Based Medicine. The authors then summarize essentials for using TMS therapy in routine clinical practice settings derived from discussions and polls of cTMSs members. Finally, each summary clinical recommendation is presented with the substantiating peer-reviewed, published evidence supporting that recommendation. When the current published clinical trial evidence was insufficient or incomplete, expert opinion was included when sufficient consensus was available from experienced clinician users among the membership of the cTMSs, who were polled at the Annual Meetings in 2014 and 2015. CONCLUSIONS: Daily left prefrontal TMS has substantial evidence of efficacy and safety for treating the acute phase of depression in patients who are treatment resistant or intolerant. Following the clinical recommendations in this document should result in continued safe and effective use of this exciting new treatment modality.
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Repetitive transcranial magnetic stimulation (rTMS) was cleared by the U.S. Food and Drug Administration (FDA) in 2008 as a treatment for major depressive disorder (MDD).
“Repetitive transcranial magnetic stimulation (rTMS) was cleared by the U.S. Food and Drug Administration (FDA) in 2008 as a treatment for major depressive disorder (MDD).”
From Neurocognitive effects of theta burst stimulation for treatment-resistant depression in adults: A systematic review and recommendations for future research (2025) · cites this paper as Perera et al., 2016
PFC has emerged as a hub for MDD treatment, as rTMS targeting left PFC appears effective in mitigating depression symptoms.
“The PFC has also emerged as a hub for MDD treatment, as repeated transcranial magnetic stimulation (rTMS) therapy targeting the left PFC appears effective in mitigating depression symptoms 207.”
From Mechanisms of synaptic transmission dysregulation in the prefrontal cortex: pathophysiological implications (2022) · cites this paper as [207]
rTMS is approved and used clinically as a treatment for medication-resistant depression in various jurisdictions.
“rTMS is now approved and used clinically as a treatment for medication-resistant depression in a variety of jurisdictions around the world (Lefaucheur et al., 2014; Milev et al., 2016; Perera et al., 2016).”
From Cortico-striatal-thalamic loop circuits of the salience network: A central pathway in psychiatric disease and treatment (2016) · cites this paper as Perera et al., 2016
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Deep transcranial magnetic stimulation (dTMS)—Beyond depression
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- Authors
- Perera, T., George, M. S., Grammer, G., Janicak, P. G., Pascual-Leone, A., & Wirecki, T. S.
- Affiliations
- Medical University of South Carolina (US)
- Northwestern University (US)
- Corresponding author
- George, Mark S.
- Venue
- Brain Stimulation
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 9
- Issue
- 3
- Pages
- 336-346
- ISSN
- 1876-4754 (ISSN-L)
- 1935-861X
- PMC
- PMC5612370
- OpenAlex
- W2302097048
- Cited by
- 674
- References
- 73
- Citations by year
- 2026: 48 · 2025: 79 · 2024: 72 · 2023: 72 · 2022: 74 · 2021: 91 · 2020: 68 · 2019: 91 · 2018: 41 · 2017: 28 · 2016: 9
- FWCI
- 30.86
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Brain stimulation (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- BrainsWay
- National Institute of Mental Health (R21MH099196)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- transcranial magnetic stimulation, major depressive disorder, treatment-resistant depression, antidepressant treatment, left prefrontal cortex, treatment guidelines, treatment efficacy and safety, level of evidence
- MeSH terms
- Adult, Antidepressive Agents, Major Depressive Disorder, Humans, Societies, Medical, Treatment Outcome, Prefrontal Cortex, Evidence-Based Medicine, Transcranial Magnetic Stimulation
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