Authors' objectives: Major depressive disorder (MDD) is a leading cause of disability in the United States and in other developed countries. Approximately one-third of patients with nonpsychotic MDD may be treatmentresistant, based on failures of at least 2 trials of antidepressants. Description of Technology: Low frequency repetitive transcranial magnetic stimulation (LFrTMS) is a noninvasive treatment that applies brief, repetitive magnetic pulses, to the right dorsolateral prefrontal cortex (DLPFC). Each train consists of a specific number of low-frequency (1 hertz) stimulations and are spaced by intertrain intervals during which no stimulation is applied. Each session takes approximately 40 minutes. A full course of repetitive transcranial magetic stimulation (rTMS) usually involves 1 session a day, 5 days a week for 2 weeks. It is believed that the prefrontal cortex is differentially engaged in regulating mood. Specifically, the right hemisphere is thought to mediate negative mood while the left mediates positive mood. The rTMS as applied to the prefrontal cortex is purported to enhance or decrease cortical excitability depending on placement. Whereas high frequency repetitive transcranial magnetic stimulation (HFrTMS) is applied to the left DLPFC and is used to induce cortical excitability, proponents suggest that applying LFrTMS to the right DLPFC creates a suppressive effect and thereby produces antidepressant results. Patient Population: LFrTMS is used to treat a number of disorders including, but not limited to, schizophrenia, obsessive compulsive disorder, and tinnitus. This health technology assessment is specifically focused on the therapeutic use of LFrTMS for treatment-resistant MDD in adults. Clinical Alternatives: Transcranial magnetic stimulation was initially developed as a physiologically similar but potentially more acceptable alternative to electroconvulsive therapy, which involves delivering electrical pulses to the brain via electrode pads positioned on the scalp above mood centers in the brain. Other clinical alternative approaches to treatment-resistant MDD include vagus nerve stimulation, deep brain stimulation, magnetic seizure therapy (also called magnetic convulsion therapy), epidural cortical stimulation, and cranial electric (or electrotherapy) stimulation.

Project Status: Completed

Year Published: 2016

URL for published report: The report may be purchased from: http://www.hayesinc.com/hayes/crd/?crd=51346

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: HAYES, Inc.

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Contact Email: saleinfo@hayesinc.com

Copyright: 2014 Winifred S. Hayes, Inc