https://orcid.org/0000-0002-5385-8188
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Abstract
Introduction
Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a promising alternative to psychotherapeutic and pharmacological treatments for depression. This paper aims to present a practical guide for its clinical implementation based on evidence from the literature as well as on the experience of a group of leading German experts in the field.
Methods
The current evidence base for the use of rTMS in depression was examined via review of the literature. From the evidence and from clinical experience, recommendations for the use of rTMS in clinical practice were derived. All members of the of the German Society for Brain Stimulation in Psychiatry and all members of the sections Clinical Brain Stimulation and Experimental Brain Stimulation of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Mental Health were invited to participate in a poll on whether they consent with the recommendations.
Findings
Among rTMS experts, a high consensus rate could be identified for clinical practice concerning the setting and the technical parameters of rTMS treatment in depression, indications and contra-indications, the relation of rTMS to other antidepressive treatment modalities and the frequency and management of side effects.
Acknowledgement
None.
Statement of interest
Michael Groezinger has done lectures and workshops on Electroconvulsive Therapy for hospitals, professional societies and other institutions and hase been paid for some of these; Tobias Hebel has had travel expenses paid for by Nexstim plc.; Sarah Kayser receipted non-financial competing interests in terms of MST and TMS devices from MagVenture; Rene Hurlemann has received honoraria from companies (Atheneum, Lundberg/Otsuka and Rovi) for lecturing and consulting which may be affected by the research reported in the enclosed paper. He has disclosed those interests fully to Taylor & Francis; Jens Kuhn has received honoraria from Bayer, Janssen, Lundbeck, Neuraxpharm, Otsuka Pharma, Schwabe and Servier for lecturing at conferences and financial support to travel. He has received financial support for Investigator initiated trials from Medtronic GmbH. Berthold Langguth received technical support from non-invasive brain stimulation companies (Nexstim, Deymed, MagVenture, NeuroConn), research support from Neuromod and received speaker fees or honoraria for advisory board participation from Schwabe, Servier, Neuromod and Desyncra; Frank Padberg is a member of the European Scientific Advisory Board of Brainsway Inc., Jerusalem, Israel, and has received speaker’s honoraria from Mag&More GmbH (Munich Germany) and the neurocare group AG (Ilmenau/Munich, Germany). His lab has received support with equipment from neuroConn GmbH (Ilmenau, Germany), Mag&More GmbH (Munich, Germany) and Brainsway Inc. (Jerusalem, Israel); Martin Schecklmann received technical support from non-invasive brain stimulation companies (Nexstim, Deymed, MagVenture, NeuroConn); Since 2020 Christoph Silberbauer has received support for registration fees from Janssen and Lundbeck Austria, speaker honoraria from Lundbeck Austria, and consulting fees from Recordati; from 2018 Peter Zwanzger has received speaker fees or honoraria for advisory board participation from Janssen Pharmaceuticals, Schwabe, Servier, neuraxpharm and Medical Tribune. All these affiliations have no relevance to the work covered in the manuscript.
The following authors have no potential competing interests: Bettina Bewernick, Joachim Cordes, Jan Di Pauli, Peter Eichhammer, Nils Freundlieb, Goeran Hajak, Jacqueline Hoeppner-Buchmann, Daniel Kamp, Bernhard Kis, Peter Kreuzer, Melisande S. Lammers, Michael Landgrebe, Beatrix Lugmayer, Clemens Mielacher, Christian Nunhofer, Ulrich Palm, Timm Poeppl, Thomas Polack, Katrin Sakreida, Alexander Sartorius, Carlos Schönfeldt-Lecuona, Heiko Ullrich, David Zilles-Wegner.