Maintenance repetitive transcranial magnetic stimulation (rTMS) for relapse prevention in with depression: A review

Major depressive disorder is a highly prevalent condition with significant morbidity and mortality. Recurrent episodes occur in greater than 50% of patients within a one year period despite treatment with antidepressant medications, electroconvulsive therapy and psychotherapy. Longer antidepressant treatment may prevent relapses and recurrences. Urgent therapeutic alternatives are needed such as maintenance repetitive transcranial magnetic stimulation. The purpose of this review is to describe and discuss studies that have evaluated the safety and efficacy of this technique in the long-term treatment and relapse prevention of depression. The electronic literature on maintenance repetitive transcranial magnetic stimulation for depression was reviewed. A limited number of controlled, open-label studies as well as case series have been published on maintenance rTMS after successful response to acute rTMS. In the majority of these studies, most patients with treatment-resistant unipolar or bipolar depression with or without medications experienced either moderate or marked benefit with maintenance rTMS, sometimes remission for three months and up to eight years. Many of the reviewed studies have shown promising results, however, future well-designed sham-controlled studies are needed to confirm the long-term safety and efficacy of maintenance rTMS in the relapse prevention of depression.