Focus of the Report: The focus of this Health Technology Assessment is to evaluate the effectiveness and safety of maintenance repetitive transcranial magnetic stimulation (rTMS) compared with sham rTMS, pharmacotherapy, or combination therapy to prevent the recurrence of major depressive disorder (MDD) in adults.

Technology Description: rTMS is a noninvasive technique that involves superficial magnetic stimulation of the brain.This is achieved by passing electrical energy through a coil that applies an electromagnetic field over the scalp that penetrates the cortical surface. For treatment of MDD, the target center is the dorsolateral prefrontal cortex (DLPFC). rTMS uses brief, repetitive magnetic pulses, called trains, at either a high-frequency (e.g., ≥ 5 hertz [Hz]) or low-frequency stimulation (1 Hz). Maintenance treatment follows treatment with rTMS or other MDD treatments and usually includes 1 treatment per week and progresses to 1treatment every 2 or 4 weeks.

Controversy: The optimal parameters for maintenance rTMS treatment have not been established. In addition, the long-term effects of rTMS have not been well investigated.

Key Questions:

  1. Is maintenance rTMS effective for preventing the recurrence of MDD?

  2. How does rTMS compare with medications, psychotherapy, electroconvulsive therapy (ECT) or other brain stimulation therapies, sham treatment, or a combination of these interventions for preventing the recurrence of MDD?

  3. Is rTMS in patients in remission from MDD safe?

  4. Have definitive patient selection criteria been identified for rTMS for the recurrence of MDD?

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