Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neurostimulation technique indicated for patients with treatment-resistant unipolar major depression (TRD). The stimulation is carried out by a coil that is placed on the scalp and delivers brief magnetic pulses.

We evaluated the efficacy and safety of high-frequency stimulation to the left dorsolateral prefrontal cortex compared to sham stimulation, as well as to electroconvulsive therapy.

The current evidence indicates that rTMS is more effective than and as safe as sham, but it is not sufficient to prove that it is as effective and safe as ECT. Due to the low quality of evidence we recommend rTMS for patients with TRD with restrictions.