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Long-term effectiveness of repetitive transcranial magnetic stimulation (rTMS) in major depressive disorder (MDD)

Publication Reference

Dunner, D. L., Aaronson, S. T., Sackeim, H. A., Janicak, P. G., Carpenter, L. L., Boyadjis, T., … & Lanocha, K. (2014). A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. The Journal of clinical psychiatry, 75(12), 1394-1401.

Article Summary*

This naturalistic, observational study examined the effectiveness of rTMS in pharmacoresistant MDD over a 12 months follow-up period in 257 patients. Concomitant antidepressant medication was permitted throughout the study as well as the reintroduction of rTMS in response to the recurrence of symptoms. Patients received high-frequency (10Hz) rTMS over the left DLPFC for 6 weeks using the FDA cleared 10Hz protocol.  Some modifications to protocols occurred, such as the inclusion of low-frequency right DLPFC stimulation, or reduced intensity. However, these alterations were not found to impact outcomes.

A clinically and statistically significant reduction in depression severity (primary outcome; Clinical Global Impressions – Severity of Illness Scale) was observed at treatment completion, with 120 patients classified as responders or remitters. Furthermore, this benefit was sustained within 62.5% of these patients at 12 months follow-up. Concomitant medication or adjustments to medication during the 12 months period were found to have no significant relationship with improvements in depressive symptoms. The authors concluded that rTMS is as effective or superior to other treatment methods for MDD.


*For original abstract/publication see the link below.


Publication link: 1-Year-Follow-Up-Study.pdf (


Study Protocol US/UK&EU/Canada only

Stimulation site Power

(motor threshold %)

Freq Train duration No. of pulses Intertrain interval (wait time) No. of trains Total no. of pulses Approx. session duration
Left DLPFC 120% resting MT 10Hz


4s 40 26s 75 3000 37.5 mins

10Hz protocol parameters with 26 seconds wait time




Visual representation of the 10Hz protocol

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