Transcranial magnetic stimulation: a device intended for the psychiatrist's office, but what is its future clinical role?

Repetitive transcranial magnetic stimulation (TMS) is a novel, noninvasive, office-based device technology that delivers focused stimulation to the cortex of the brain by means of magnetic pulses. It is a promising therapeutic approach in a variety of neuropsychiatric disorders. A large number of clinical trials have examined repetitive TMS as a novel treatment for major depression, with additional significant work in schizophrenia, anxiety disorders and pain syndromes. In this review, we describe how repetitive TMS is administered clinically and discuss how excitatory and inhibitory forms of stimulation are applied depending on what is known of the underlying pathophysiology of the disorder. Future putative clinical applications of repetitive TMS in psychiatry are discussed, with the authors’ perspective on its likely role in clinical practice. TMS is a promising form of neuromodulation therapy that will most likely become a significant part of clinical practice in the future.