Repetitive Transcranial Magnetic Stimulation Using the NeuroStar System for Treating Major Depressive Disorder

Proprietary names: NeuroStar TMS Therapy System, SenStar Treatment Link, MT Assist

Generic names: Transcranial magnetic stimulation system

Major depressive disorder (MDD) is a serious mental illness characterized by one or more major depressive episodes. A subset of MDD is thought to have a biologic basis. Although the pathophysiology underlying MDD is not clearly understood, it seems to include a disturbance in central nervous system serotonin, norepinephrine, and/or dopamine activity.1 Areas of the brain believed to be involved in serotonin-mediated depressive symptoms include the dorsal raphe nucleus, the limbic system, and the left prefrontal cortex.1

According to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria, a patient must present with at least five symptoms from the following list during the same two-week period, and this must represent a change from prior functioning to diagnose MDD.2 One of the five symptoms must include the first or second symptom below:2

First-line treatments for MDD typically consist of the following:3

As many as half of patients do not achieve any or adequate symptom relief from first-line treatment.1 For these patients, clinicians typically prescribe one of the following treatments as second- or third-line treatment:4,5

In some cases, ECT is considered first-line therapy (e.g., in patients who have had previous success with ECT, patients with severe MDD combined with psychotic features, catatonia, suicide risk, or food refusal leading to nutritional compromise).6 VNS is approved for patients whose symptoms have not responded...