Transcranial magnetic stimulation (TMS, or "rTMS" for "repetitive TMS") received an indication for treating major depressive disorder in 2008. Since then, research and clinical experience with TMS has been growing, and recent applications include rapid "accelerated" TMS for depression1 and indications for obsessive-compulsive disorder, depression in teens 15 years of age and older, and for smoking cessation.

Briefly (see reference 1 below for more detail), TMS applies a fluctuating magnetic field, generated by an electromagnetic coil, to stimulate key brain regions associated with various clinical conditions.

During TMS, a magnetic coil is placed against the scalp, and treatment is administered over a period of time for multiple sessions, requiring no sedation or anesthesia, no need for recovery following the procedure, and an excellent safety profile. For depression, the area treated is typically the left dorsolateral prefrontal cortex (LDLPFC). TMS increases activity in this key "executive function" area, leading to beneficial changes throughout brain networks related to emotion regulation, decision-making, cognition, and other key functional areas.

TMS has been found to be safe and effective, with complete resolution in more than 70 percent of people with depression for some protocols, and correspondingly high response rates, defined as at least a 50 percent reduction in symptoms. TMS tends to be durable, though some patients become depressed again, often with partial symptoms, and benefit from re-treatment or maintenance.

By contrast, data on medications shows that up to 36 percent of patients have a full resolution of depression overall—given multiple medication trials—with less than 30 percent responding well with the first medication. About one-third don't see benefit with the first medication,........

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