Five facts about rTMS

In recent articles published in the ANZJP, we have raised important concerns regarding the use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression. Some of these articles are detailed and lengthy, and many busy clinicians may not have sufficient time to assimilate all the facts. Therefore, in this brief Commentary we have succinctly summarised these concerns for clarity and ease of reference.

The points that we have drawn attention to are relevant to clinical practice and the delivery of this experimental intervention. Therefore, they warrant further careful consideration before the intervention can be regarded as part of routine clinical practice – alongside other recognised and robustly tested therapies such as psychological interventions, pharmacotherapy and electroconvulsive therapy (ECT). These important facts are outlined below.

Five facts about rTMS a
1. Lacks comparative efficacy in the management of clinical depression (Malhi et al., 2021d).
2. Tolerability and safety have been over-emphasised and serious potential harms have been overlooked (Malhi et al., 2021a).
3. Claimed benefits are almost completely attributable to placebo and non-specific effects (PANSE) (Malhi and Bell, 2021).
4. It is not known what kind of depression b is suited to rTMS. Note, treatment-resistant depression (TRD) is not a diagnostic subtype (Malhi et al., 2021c).
5. There is a startling paucity of basic neuroscience and animal studies investigating the effects of rTMS on neural functioning (Malhi et al., 2021b).

rTMS: repetitive transcranial magnetic stimulation.

a

Note, in addition to publishing in the ANZJP, we have also drawn attention to these issues in the Canadian Journal of Psychiatry; however, here we have referred only to the literature featured in this journal.

b

Or indeed what kind of patient characteristics are best suited to rTMS.