Purpose of Technology: Repetitive high-frequency left transcranial magnetic stimulation (HFL-rTMS) is a noninvasive technique that may serve as an alternative intervention for treatment-resistant depression (TRD). Brief repetitive pulses of magnetic energy are applied to the scalp via a large electromagnetic coil, thereby modulating electrical current in the underlying cortical tissue. The goal of HFL-rTMS is to influence activity in areas of the brain involved in mood regulation, in order to shorten the duration or reduce the severity of depressive episodes. HFL-rTMS may be used to augment current pharmacotherapy or as a primary treatment strategy for medication-free patients.
Controversy: The comparative effectiveness and safety of HFL-rTMS relative to electroconvulsive therapy (ECT), ECT combined with HFL-rTMS (ECT+HFL-rTMS), and bilateral repetitive transcranial magnetic stimulation (rTMS) in patients who have not responded to pharmacotherapy are unknown.
How does HFL-rTMS compare with ECT and bilateral rTMS with regard to improvement of depression symptoms for patients with TRD?
How does HFL-rTMS compare with ECT and bilateral rTMS with regard to rates of response and remission for patients with TRD?
How does HFL-rTMS compare with ECT and bilateral rTMS with regard to safety for patients with TRD?
Have definitive patient selection criteria been established for HFL-rTMS, ECT, and bilateral rTMS?
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