RANZCP guidelines

Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB.


This article provides guidance for the management of mood disorders, based on scientific evidence and the expert opinions of psychiatrists. The article describes how depression is diagnosed and the recommended treatment pathway, including the use of TMS, in Australian patients. The recommendations in this paper are used by doctors to treat patients with mental health conditions.

The effects of transcranial magnetic stimulation last for at least 12 months for most patients that respond to treatment

Dunner DL, Aaronson ST, Sackeim HA, Janicak PG, Carpenter LL, Boyadjis T, Brock DG, Bonneh-Barkay D, Cook IA, Lanocha K, Solvason HB, Demitrack MA.


This study followed up patients enrolled in Dr Carpenter’s 2012 study for a duration of 1 year.

The results show that with appropriate maintenance the effects of TMS last for at least 1 year in 71% of patients who enter remission, and in 62% of patients who respond. It also shows that if a patient relapses after a course of TMS, they have a very high chance of benefitting from another course of treatment.

At 6 weeks, TMS is superior to sham and to most other treatment options for depression

Katerina Papadimitropoulou, Carla Vossen, Andreas Karabis, Christina Donatti and Nicole Kubitz


This paper describes a very interesting systematic review and network meta-analysis exploring interventions for treatment resistant depression including TMS, ECT and various pharmacological interventions. The authors reviewed a total of 31 randomised controlled trials across all three intervention types. Perhaps not surprisingly given that the authors were predominantly from the pharmaceutical industry, the benefits of several antipsychotic drugs were highlighted in the abstract. However, this really misrepresents the findings within the paper which are far more in favour of non-pharmacological treatments.

In particular, when looking at remission and response rates, especially those at four and six weeks (compared to at two weeks), TMS came out looking far and away the most effective treatment intervention. For response rates at four weeks, aripiprazole, ECT and TMS were seen to be effective but the response rates were greatest with TMS. At six week assessment, only TMS demonstrated response rates that were statistically significantly greater than placebo stimulation.

The data describing remission rates at four and six weeks also was quite favourable to TMS: TMS was one of three interventions (including aripiprazole and ECT) that were effective at four weeks and at six weeks it was again the intervention with the highest remission rates and the only intervention where effects were statistically significant (Fig. 4).

This data provides extremely strong support for the relative efficacy of TMS compared to other interventions in patients with treatment resistant depression. It clearly indicates that TMS treatment is as good as, and most likely superior, to most other interventions that are provided to patients who meet criteria for treatment resistance.

Professor Paul B. Fitzgerald

The effects of repetitive transcranial magnetic stimulation (TMS) in the treatment of depression

Paul B Fitzgerald and Zafiris J Daskalakis


Research into the use of repetitive TMS for the treatment of patients with depression has been conducted for over 15 years. The aim of this article was to review the development of repetitive TMS as a depression treatment. Most of the trials conducted on the technique have evaluated the efficacy of high-frequency repetitive TMS when applied to the left dorsolateral prefrontal cortex

Research into the use of rTMS for the treatment of patients with depression has now been conducted for over 15 years. The aim of this article was to review the development of rTMS treatment for depression and the current state of evidence supporting its use. The vast majority of the trials conducted on the technique have evaluated the efficacy of high-frequency rTMS applied to the left dorsolateral prefrontal cortex using a set of parameters very similar to those originally described in the mid-1990s.

TMS is an effective treatment for major depression, resistant to medication

Carpenter LL, Janicak PG, Aaronson ST, Boyadjis T, Brock DG, Cook IA, Dunner DL, Lanocha K, Solvason HB, Demitrack MA.


In this study from 2012, Dr Carpenter and colleagues used TMS to treat patients with major depression. Those patients who did not benefit from one or more antidepressant underwent 30 sessions of TMS over a 6-week period. Clinicians assessed the effects after completion and found that 37% of patients entered remission, and 58% responded. Overall, the treatment was very tolerable and patients adhered well to treatment.

Catalyst season 16 episode 12 on Brain Stimulation

Prof. Paul Fitzgerald was interviewed on the ABC and shows you what is involved in a TMS treatment session

Dr Cassidy explains Transcranial Magnetic Stimulation