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Tijdschrift voor Psychiatrie 61 (2019) 6, 411 - 420

Essay

Consensus statement on the application of rTMS in depression in the Netherlands and Belgium

M. Arns, C. Bervoets, P. van Eijndhoven, C. Baeken, O.A. van den Heuvel, A. Aleman, D.J.L.G. Schutter, Y. van der Werf, S. van Belkum, I.E. Sommer, R. van Ruth, B. Haarman, J. Spijker, A.T. Sack

background Since 2017, repetitive transcranial magnetic stimulation (rtms) has become eligible for reimbursement for the treatment of therapy-resistant depression in the Dutch healthcare system.
aim To initiate a guideline in the Netherlands and Belgium for the safe and effective application of rtms for the treatment of depression.
method Based on literature review, existing guidelines and consensus among Dutch rtms experts, recommendations were developed regarding the implementation of rtms as a treatment of depression. All available evidence was weighed and discussed among all co-authors and recommendations were reached by consensus among the group.
results rtms targeting the dorsolateral prefrontal cortex (dlpfc) should be seen as a first choice in the treatment of depression using high-frequency rtms (left) or, as an alternative, low-frequency rtms (right). Stimulation protocols should use more than 1000 pulses per session for an average of 20-30 sessions, offered in 2-5 sessions per week. Contraindications for rtms include epilepsy, intracranial presence of (magnetisable) metals, pacemaker and cochlear implant.
conclusion rtms, performed by competent professionals is an effective and safe treatment for depression.

keywords brain stimulation, depression, neuromodulation