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15: Repetitive Transcranial Magnetic Stimulation (rTMS)

Risk Management and Treatment » Pharmacologic and other Somatic Treatments
15: Repetitive Transcranial Magnetic Stimulation (rTMS)

There is insufficient evidence to recommend for or against repetitive transcranial magnetic stimulation to reduce the risk of suicide or suicide attempts.

Strength:

Neither for or against

Category:

ReviewedNew-added

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Repetitive transcranial magnetic stimulation (rTMS) is a procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms on major depression disorder (MDD). During an rTMS session, an electromagnetic coil is placed against the scalp of the patient’s head. The coil delivers magnetic pulses that stimulate nerve cells in the region of the brain involved in mood. While rTMS is effective in improving symptoms for patients with MDD who had partial or no response to two or more medication treatment trials, there is much less evidence assessing the impact of rTMS on suicide attempts or suicide deaths.

Training Resources

This section includes links to trainings about repetitive transcranial magnetic stimulation.

VA rTMS Resources
Somatic Treatment Community of Practice SharePoint (requires access to VA networks)
Transcranial Magnetic Stimulation (TMS) SharePoint (requires access to VA networks)
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Videos

This section includes videos about repetitive transcranial magnetic stimulation.

video thumbnail Repetitive Transcranial Magnetic Stimulation for Suicide Prevention from McLean Hospital
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Webinars

This section includes links to webinars that are recommend about repetitive transcranial magnetic stimulation.

Clinical Use of Transcranial Magnetic Stimulation for Suicide Prevention Presented by Dr. Nolan Williams
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Articles

This section includes links to recommended articles about Crisis Response Planning and the Safety Planning Initiative.

Cole, E. J., Phillips, A. L., Bentzley, B. S., Stimpson, K. H., Nejad, R., Barmak, F., Veerapal, C., Khan, N., Cherian, K., Felber, E., Brown, R., Choi, E., King, S., Pankow, H., Bishop, J. H., Azeez, A., Coetzee, J., Rapier, R., Odenwald, N., Carreon, D., … Williams, N. R. (2022). Stanford Neuromodulation Therapy (SNT): A Double-Blind Randomized Controlled Trial. The American journal of psychiatry, 179(2). 132–141. https://doi.org/10.1176/appi.ajp.2021.20101429
Cole, E. J., Stimpson, K. H., Bentzley, B. S., Gulser, M., Cherian, K., Tischler, C., Nejad, R., Pankow, H., Choi, E., Aaron, H., Espil, F. M., Pannu, J., Xiao, X., Duvio, D., Solvason, H. B., Hawkins, J., Guerra, A., Jo, B., Raj, K. S., Phillips, A. L., … Williams, N. R. (2020). Stanford Accelerated Intelligent Neuromodulation Therapy for Treatment-Resistant Depression. The American journal of psychiatry, 177(8). 716–726. https://doi.org/10.1176/appi.ajp.2019.19070720
Hines, C. E., Mooney, S., Watson, N. L., Looney, S. W., & Wilkie, D. J. (2022). Repetitive Transcranial Magnetic Stimulation Promotes Rapid Psychiatric Stabilization in Acutely Suicidal Military Service Members. The journal of ECT, 38(2). 103–109. https://doi.org/10.1097/YCT.0000000000000810
McQuaid, J. R., Buelt, A., Capaldi, V., Fuller, M., Issa, F., Lang, A. E., Hoge, C., Oslin, D. W., Sall, J., Wiechers, I. R., & Williams, S. (2022). The Management of Major Depressive Disorder: Synopsis of the 2022 U. . Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Annals of internal medicine, 175(10). 1440–1451. https://doi.org/10.7326/M22-1603
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