Investigators: Kim Peterson, MS; Ellen McCleery, MPH; Kallie Waldrip, MS; Mark Helfand, MD, MPH, MS
Evidence-based Synthesis Program (ESP) Coordinating Center, Portland VA Medical Center,
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Major depressive disorder is one of the most common mental disorders in the general and Veteran populations. The one-to two-thirds of MDD patients who do not respond to the first antidepressant prescribed, and the 15% to 33% who do not respond to multiple drugs are defined as having treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is one of many possible options for treating TRD. It is supported by two FDA-cleared protocols and acceptable acute efficacy based on a recent Comparative Effectiveness Review conducted by the RTI-UNC EPC. This Evidence Brief synthesizes the literature on factors that optimize rTMS therapy in patients with TRD.
Key Question #1: Which patients have the best chance of success with rTMS?
Key Question #2: What are the optimal rTMS treatment protocols and parameters?
Key Question #3: What is known about the continuation and maintenance treatment in reponders?