Transcranial magnetic stimulation for major depressive disorder: What a pharmacist should know

Transcranial magnetic stimulation utilizes strong pulsed magnetic fields from an insulated coil which generate electrical currents resulting in neuronal depolarization in the cortex. Currently, the user manual only cautions against the use of tricyclic antidepressants, antipsychotics, and other medications that lower the seizure threshold during TMS therapy. However, post-marketing reports suggest caution should also be utilized when combining TMS with other antidepressants (e.g. bupropion, serotonin reuptake inhibitors) and stimulants. Data show efficacy of approximately 30%. Adverse effects more commonly reported include application site pain (35.8%), muscle twitching (20.6%), application site discomfort (10.9%), skin pain (8.5%), toothache (7.3%), facial pain (6.7%), and eye pain (6.1%).