The International Journal of Neuropsychopharmacology

Review Article

A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression

Colleen K. Looa1a2a3 c1, Tara F. McFarquhara1a3 and Philip B. Mitchella1a3

a1 School of Psychiatry, University of New South Wales, Sydney, Australia

a2 St George Hospital, South Eastern Sydney Illawarra Area Health Service, Australia

a3 Black Dog Institute, Sydney, Australia


There is growing interest worldwide in rTMS as a clinical treatment for depression. Apart from efficacy, its safety as a clinical treatment must be considered before its widespread use can be advocated. All published, sham-controlled rTMS depression trials were reviewed for reported side-effects and outcomes of formal neuropsychological testing. In addition, all reports of seizures occurring with rTMS were reviewed. Other safety concerns (effects on hearing; headache, pain, induced currents in electrical circuits, histotoxicity, electromagnetic field exposure, psychiatric complications, safety in pregnancy) are discussed. Common side-effects were of a minor nature, e.g. headache. There was a low incidence of accidental seizures and induced hypomania, both of which were associated with identified risk factors for which subjects should be screened. Long-term effects of repeated rTMS sessions are as yet unknown. When given within recommended guidelines, the overall safety profile of rTMS is good, and supports its further development as a clinical treatment.

(Received November 26 2006)

(Reviewed January 10 2007)

(Revised January 23 2007)

(Accepted February 10 2007)


c1 Address for correspondence: Associate Professor C. Loo, Black Dog Institute, Prince of Wales Hospital, Randwick, NSW 2031, Australia. Tel.: 61-2-9382 3721 Fax: 61-2-9382 8208 E-mail: