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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
Open accessAbstract
• 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.
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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).”
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 Trapp et al., 2025
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Neacsiu, A. D., Luber, B. M., Davis, S. W., Bernhardt, E. R., Strauman, T. J., & Lisanby, S. H. (2018) · Journal of Ect · doi:10.1097/yct.0000000000000545 · Cited by 45
Self-citationSound comparison of seven TMS coils at matched stimulation strength
Koponen, L. M., Goetz, S. M., Tucci, D. L., & Peterchev, A. V. (2020) · Brain stimulation · doi:10.1016/j.brs.2020.03.004 · Cited by 45
George, M. S., Huffman, S. M., Doose, J., Sun, X., Dancy, M. M., Faller, J., Li, X., Han, Y., Goldman, R. I., Sajda, P., et al. (2023) · Brain stimulation · doi:10.1016/j.brs.2023.11.010 · Cited by 45
Depressive symptom trajectories associated with standard and accelerated rTMS
Kaster, T. S., Chen, L., Daskalakis, Z. J., Hoy, K. E., Blumberger, D. M., & Fitzgerald, P. B. (2020) · Brain stimulation · doi:10.1016/j.brs.2020.02.021 · Cited by 44
Self-citationElectroconvulsive Therapy in Pregnancy: Safety, Best Practices, and Barriers to Care
Rose, S. J., Dotters-Katz, S. K., & Kuller, J. A. (2020) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0000000000000763 · Cited by 44
Chen, L., Hudaib, A., Hoy, K. E., & Fitzgerald, P. B. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.09.035 · Cited by 44
Seizure risk with repetitive TMS: Survey results from over a half-million treatment sessions
Taylor, J. J., Newberger, N. G., Stern, A. P., Phillips, A., Feifel, D., Betensky, R. A., & Press, D. Z. (2021) · Brain stimulation · doi:10.1016/j.brs.2021.05.012 · Cited by 44
Self-citationRazza, L. B., dos Santos, L. A., Borrione, L., Bellini, H., Castelo-Branco, L. E. C., Cretaz, E., Duarte, D. G. G., Ferrão, Y. A., Galhardoni, R., Quevedo, J., et al. (2020) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2020-1169 · Cited by 43
Corlier, J., Tadayonnejad, R., Wilson, A. C., Lee, J. C., Marder, K. G., Ginder, N. D., Wilke, S. A., Levitt, J. G., Krantz, D. E., & Leuchter, A. F. (2021) · Psychological Medicine · doi:10.1017/s0033291721002178 · Cited by 43
Efficacy of Deep TMS with the H1 Coil for Anxious Depression
Pell, G. S., Harmelech, T., Zibman, S., Roth, Y., Tendler, A., & Zangen, A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11041015 · Cited by 43
Hutton, T. M., Aaronson, S. T., Carpenter, L. L., Pages, K. P., West, W. S., Kraemer, C., & Sackeïm, H. A. (2023) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.22m14571 · Cited by 42
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Flagged first, then by citations
3 of the 316 references couldn’t be matched to a known paper.
Research works printed but not linked: 8
- Cash, 2020, Using brain imaging to improve spatial targeting of transcranial magnetic stimulation for depression, Biol Psychiatry
- Cole, 2021, Stanford Neuromodulation Therapy (SNT): a double-blind randomized controlled trial, Am J Psychiatry
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Cited by
Sorted by citations
Taylor, J. J., Li, J., Lin, C., Jones, E., Frandsen, S. B., Becker, C. R., Drew, W., Haj-Darwish, D., Jabbour, S., Leach, J., et al. (2026) · Molecular Psychiatry · doi:10.1038/s41380-026-03535-1 · Cited by 26
Self-citationThe future of psychiatry: clinical practice, diagnosis, and treatment
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Trapp, N. T., Liu, X., Li, Z., Bruss, J., Keller, C. J., Boes, A. D., & Jiang, J. (2025) · Brain stimulation · doi:10.1016/j.brs.2025.06.011 · Cited by 9
Self-citationMicrowave technologies for biomedical diagnosis and therapy: advances, challenges, and perspectives
Montoya-Villada, S., Reyes-Vera, E., & Orozco, J. (2026) · Microchimica Acta · doi:10.1007/s00604-025-07826-2 · Cited by 7
Metadata
- Authors
- Trapp, N. T., Purgianto, A., Taylor, J. J., Singh, M. K., Oberman, L. M., Mickey, B. J., Youssef, N. A., Solzbacher, D., Zebley, B., Cabrera, L. Y., Conroy, S., Cristancho, M., Richards, J. R., Flood, M. J., Barbour, T., Blumberger, D. M., Taylor, S. F., Feifel, D., Reti, I. M., McClintock, S. M., Lisanby, S. H., & Husain, M. M.
- Affiliations
- University of Iowa (US)
- Brigham and Women's Hospital (US)
- University of California, Davis (US)
- National Institute of Mental Health (US)
- University of Utah (US)
- Pine Rest Christian Mental Health Services (US)
- NewYork–Presbyterian Hospital (US)
- Pennsylvania State University (US)
- Indiana University School of Medicine (US)
- University of Pennsylvania (US)
- Harvard University (US)
- Centre for Addiction and Mental Health (CA)
- University of Michigan (US)
- University of California San Diego (US)
- Johns Hopkins University (US)
- The University of Texas Southwestern Medical Center (US)
- Duke University (US)
- Corresponding author
- Trapp, Nicholas T.
- ORCID
- Trapp, Nicholas T.
- Purgianto, Anthony
- Taylor, Joseph J.
- Singh, Manpreet K.
- Oberman, Lindsay M.
- Mickey, Brian J.
- Youssef, Nagy A.
- Cabrera, Laura Y.
- Conroy, Susan
- Cristancho, Mario
- Richards, Jackson R.
- Barbour, Tracy
- Blumberger, Daniel M.
- Taylor, Stephan F.
- Feifel, David
- Reti, Irving M.
- McClintock, Shawn M.
- Lisanby, Sarah H.
- Husain, Mustafa M.
- Venue
- Clinical Neurophysiology
- Publisher
- Elsevier BV
- Published
- 2025-02
- Volume
- 170
- Pages
- 206-233
- ISSN
- 1388-2457 (ISSN-L)
- PMC
- PMC11825283
- OpenAlex
- W4405585988
- Cited by
- 89
- References
- 316
- Citations by year
- 2026: 65 · 2025: 23
- FWCI
- 13.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Neurophysiology (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- National Institute of Mental Health (R21MH128815, R01MH112815, 5R01MH121542, K23MH129829, 1K23MH125145, R01MH113929)
- American Foundation for Suicide Prevention (5R01MH121542, DIG-1\u2013134\u201322)
- Canadian Institutes of Health Research (R01MH112815, R21MH128815, R01MH1192850)
- American Academy of Child and Adolescent Psychiatry
- Patient-Centered Outcomes Research Institute
- Fondation Brain Canada
- ACMH Foundation
- National Institutes of Health
- Campbell Family Mental Health Research Institute
- Brain and Behavior Research Foundation (21875, 31081)
- Columbia University
- National Institute on Alcohol Abuse and Alcoholism (1R21AA030372)
- U.S. Department of Health and Human Services
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Keywords
- repetitive transcranial magnetic stimulation, depression, intermittent theta burst stimulation, TMS safety, clinical documentation, treatment-resistant depression, special populations
- MeSH terms
- Depression, Humans, Neurophysiology, Societies, Medical, Consensus, Transcranial Magnetic Stimulation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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