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Updated: Dec 14, 2025
Conventional Repetitive Transcranial Magnetic Stimulation for Depression: A Step-by-Step Protocol
Published on: November 21, 2025
A Clinical Program to Implement Repetitive Transcranial Magnetic Stimulation for Depression in the Department of
Whitney T Carrico1, Gerald Georgette1, Michelle R Madore1
1is a Fellow in the Veterans Affairs (VA) War Related Injury and Illness Study Center; is a Clinical Research Nurse Coordinator; is Director of the VA National Clinical Repetitive Transcranial Magnetic Stimulation (TMS) Pilot Program; is an Attending Psychiatrist and Director of the Neuromodulation Clinic; is Director, Outpatient Mental Health; is Chief, Psychology Service; and is an Associate Chief of Staff for Mental Health and Director of the Mental Illness Education, Research and Clinical Centers; all at VA Palo Alto Health Care System in California. is Director of the TMS Clinic and a Staff Psychiatrist at James A. Haley Veterans Hospital; and a Professor, University of South Florida in Tampa. is a Distinguished University Professor of Psychiatry, Neurology and Radiology and Director of the Brain Stimulation Division, Medical University of South Carolina, and a Staff Psychiatrist and Director of the TMS Clinic at Ralph H. Johnson VA Medical Center in Charleston. Steven Lindley and Jong Yoon are Associate Professors of Psychiatry; and Jerome Yesavage is an Associate Chair of Psychiatry and Behavioral Sciences and Professor of Neurology and Neurological Sciences (by courtesy); all at Stanford University School of Medicine in Palo Alto.
Background:
Repetitive transcranial magnetic stimulation (rTMS) uses a device to create magnetic fields that cause electrical current to flow into targeted neurons in the brain. The most common clinical use of rTMS is for the treatment of major depressive disorder (MDD). The annual suicide rate of veterans has been higher than the national average; treating depression with rTMS would likely decrease suicide risk. MDD in many patients can be chronic and reoccurring with medication and psychotherapy providing inadequate relief.
Methods:
A pilot program was created to supply rTMS devices to 35 different sites in the VA nationwide in order to treat treatment-resistant depression.
Conclusions:
At time of analysis more than 950 veterans have started the program and 412 have finished. Nationwide, we have seen the depression scores decline, indicating an improvement in well-being. In addition, there is high patient satisfaction. Collecting data on a national level is a powerful way to examine rTMS efficacy and predictors of response which might be lost on a smaller subset of cases.
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