Transcranial magnetic stimulation in the treatment of depression

tion (TMS) is a noninvasive and easily toler-ated method of altering cortical physiology. The authors evaluate evidence from the last decade supporting a possible role for TMS in the treatment of depression and ex-plore clinical and technical considerations that might bear on treatment success. Method: The authors review English-lan-guage controlled studies of nonconvulsive TMS therapy for depression that appeared in the MEDLINE database through early 2002, as well as one study that was in press in 2002 and was published in 2003. In addition, the authors discuss studies that have examined technical, methodological, and clinical treatment parameters of TMS. Results: Most data support an antide-pressant effect of high-frequency repeti-tive TMS administered to the left pre-frontal cortex. The absence of psychosis, younger age, and certain brain physiologic markers might predict treatment success. Technical parameters possibly affecting treatment success include intensity and duration of treatment, but these sugges-tions require systematic testing. Conclusions: TMS shows promise as a novel antidepressant treatment. System-atic and large-scale studies are needed to identify patient populations most likely to benefit and treatment parameters most likely to produce success. In addition to its potential clinical role, TMS promises to provide insights into the pathophysiology of depression through research designs in which the ability of TMS to alter brain activity is coupled with functional neu-roimaging