A Review of Current Clinical Practice in the Treatment of Major Depression

Abstract

Transcranial magnetic stimulation (TMS) is a method of using high-strength pulsed magnetic fields to induce a depolarizing electric current in a localized area of the cerebral cortex. A large, replicated body of multisite, randomized sham-controlled studies has established the safety and effectiveness of a specific TMS device for the treatment of patients with pharmacoresistant major depressive disorder. This chapter reviews the current understanding of the physiologic effects and presumed mechanism of effect of TMS as an antidepressant. In addition, the scientific evidence base for its safety and efficacy are reviewed, along with a summary of its current acceptance by professional societies. The introduction of TMS as an office-based treatment in clinical psychiatry has introduced the need to understand the basic elements of organization and implementation of a TMS treatment option within a psychiatric clinical practice setting. This chapter provides a broad overview and specific recommendations for the organization of a TMS treatment team, and presents a basic framework and clinical approach to the implementation of TMS as a therapeutic technique. Aspects of patient diagnostic assessment, treatment planning, treatment team roles and responsibilities, and patient safety are reviewed.