2016 Volume 28 Issue 2 Pages 125-131
Previous clinical trials of repetitive transcranial magnetic stimulation (rTMS) applied to major depression have shown that the grand mean of reported effect sizes was medium and less than that of electroconvulsive therapy (ECT), although rTMS exhibited much higher safety and tolerability than ECT. Recently, the utility of rTMS has been demonstrated in terms of durability of antidepressant effects and relapse prevention, in addition to antidepressant effects during the acute phase. However, the response rate of rTMS was reported to be 30 to 40% of medication-resistant patients with major depression, which was not satisfactory. It is crucial for clinical introduction of rTMS to define a targeted clinical population and a suitable position of rTMS within a comprehensive treatment algorithm of major depression. Hypothetical antidepressant mechanisms of rTMS were addressed at the levels of neurotransmitter, neuroplasticity, and macroanatomical neuronal networks. Additionally, rTMS applications to other psychiatric disorders were briefly introduced. Finally, clinical introduction of rTMS was discussed in terms of existing situations and challenges in Japan.
