TMS Australia. A safety: a practical guide for psychiatrists
Rohan Taylor Health Education & Training Institute, Gladesville, NSW, Research Fellow, School of Psychiatry and Black Dog Institute, University of New South Wales, Randwick, NSW; Psychiatry Registrar, Concord Centre for Mental Health, Concord, NSW, Australia
Veronica Galvez Psychiatrist, School of Psychiatry, University of New South Wales, Randwick, NSW; Black Dog Institute, University of New South Wales, Randwick, NSW, Australia
Colleen Loo Professor of Psychiatry, School of Psychiatry, University of New South Wales, Randwick, NSW, and; BlackDog Institute, University of New South Wales, Randwick, NSW, and; Psychiatrist, St George Hospital, Kogarah, NSW, and Psychiatrist, The Wesley Hospital, Kogarah, NSW, Australia
Objectives: Repetitive transcranial magnetic stimulation (rTMS) is increasingly being utilised as a treatment option for depression, and with this comes a need for a practical review of safety issues intended for clinicians. This article provides an overview of the current literature regarding safety issues with rTMS for depression, and provides recommendations for clinical practice.
Conclusions: Overall, rTMS is a well-tolerated treatment with common side effects (such as headache or local pain at the site of stimulation) being mild. Severe adverse effects, such as seizures, hearing impairment or mania, are uncommon. Certain populations, including adolescents, pregnant women, older adults and those with metal/electronic implants, require special consideration when prescribing and monitoring treatment courses. With adequate assessment and monitoring processes, rTMS can be administered safely in a large proportion of depressed patients.
Assessment and monitoring
Before commencing a course of rTMS treatment, a com- prehensive psychiatric and medical history must be obtained, and relevant physical examination performed (see Table 2). As demonstrated in this review, there are very few absolute contraindications to rTMS. Nevertheless, a structured safety screen (such as that developed by Keel et al.18) is a worthwhile addition to any TMS clinic procedure. The risk/benefit ratio should be carefully considered before recommending a treatment course in certain groups (pregnant women, ado- lescents, patients with implanted electronic devices and patients with pre-existing neurological conditions). In order to enhance the collection of data relating to safety (and efficacy) outcomes, we advise clinicians providing rTMS of the formation of the CARE network – this network aims to coordinate the collection of relevant clinical data for widespread quality improvement and allow for pooling of a large, naturalistic dataset for analysis.
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