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Tijdschrift voor Psychiatrie 60 (2018) 11, 766 - 773

Review article

rTMS for treatment resistant depression – proposal for a treatment protocol

S.M. van Belkum, M.K. de Boer, G-J. Taams, D.J.L.G. Schutter, A. Aleman, R.A. Schoevers, B.C.M. Haarman

background At present, the use of repetitive transcranial magnetic stimulation (rtms) for treatment-resistant depression is sufficiently substantiated to be applied in clinical practice. In the Netherlands, it will be reimbursed when offered in combination with cognitive behavior therapy.
aim Proposal for a clinical treatment protocol for rtms in The Netherlands.
method A study of the literature and a critical appraisal of available international guidelines for rtms.
results rtms is a safe treatment for patients suffering from a moderate to severe depressive disorder that is relatively treatment-resistant. The duration of the effect is still unknown. It is advised to stimulate the left dorsolateral prefrontal cortex using an intensity of 120% of the resting motor threshold, with a frequency of 10 Hz and using 3000 pulses per session during a total of 20-30 sessions.
conclusion The proposed treatment protocol is favored based on the available evidence when rtms is used as a treatment aimed to acutely decrease the severity of depressive symptoms. It is further proposed to systematically collect technical and outcome data on treatment with rtms to further improve treatment with rtms in clinical practice.

keywords major depressive disorder, neuromodulation, repetitive transcranial magnetic stimulation, treatment resistant depression