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Updated: May 9, 2025
Treating Clinical Depression with Repetitive Deep Transcranial Magnetic Stimulation Using the Brainsway H1-coil
Published on: October 4, 2016
Treating Depression With Repetitive Transcranial Magnetic Stimulation: A Clinician's Guide
Leo Chen1, Andrew M Fukuda1, Shixie Jiang1
1Department of Psychiatry, School of Translational Medicine, Monash University and Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia (Chen); Psychiatric Neurotherapeutics Program, Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, MA and Department of Psychiatry, Harvard Medical School, Boston (Fukuda); Department of Psychiatry, University of Florida, Gainesville (Jiang); TMS Clinical and Research Program, Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior and Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles (Leuchter); Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (van Rooij, McDonald); Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge); Butler Hospital, Department of Psychiatry and Human Behavior, Alpert Medical School at Brown University, Providence, Rhode Island (Carpenter).
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Transcranial magnetic stimulation (TMS) applies electromagnetic pulses to stimulate cortical neurons. The antidepressant effect of the repetitive application of TMS (rTMS) was first shown nearly three decades ago. The therapeutic potential of TMS has been extensively investigated, mostly in treatment-resistant depression (TRD). Studies have extensively evaluated stimulation parameters, treatment schedules, methods to localize the stimulation target, and different magnetic coil designs engineered for desired stimulation breadth and depth. Several of these stimulation protocols and coils/devices have received U.S. Food and Drug Administration (FDA) clearance for application in TRD and other neuropsychiatric disorders, such as obsessive-compulsive disorder. Some stimulation protocols, while not FDA-cleared, have substantial clinical trial-derived evidence to support their safety and antidepressant efficacy. The proliferation of rTMS translational and clinical research has resulted in the field's advancement. This clinician-oriented review contains an overview of fundamental TMS principles, physiological effects, and studies of rTMS in TRD. Also discussed are two innovations that are increasingly applied in the clinic: theta burst stimulation and accelerated scheduling. A synthesis of the key clinical considerations given to patient assessment and safety, treatment setup, and the minimization and management of adverse effects is provided.
