March 19, 2026 – Repetitive Transcranial Magnetic Stimulation (rTMS), a treatment that uses magnetic pulses to stimulate specific areas of the brain, is gaining recognition as a viable option for individuals with depression. The treatment is increasingly featured in clinical guidelines, according to the Dutch Knowledge Center for Anxiety, Obsession, and Depression. As rTMS becomes more common, healthcare providers are now focusing on how to prevent relapse in patients who experience significant improvement.
Research on maintaining the benefits of rTMS after an initial course of treatment is still emerging. To address this, the Brain Stimulation Foundation developed a consensus statement for apply in the Netherlands and Flanders. This statement was based on a review of existing literature, practical experience, and input from patient representatives.
What Does “Maintenance” After rTMS Entail?
The consensus outlines three potential approaches following a successful rTMS treatment:
- Tapering: Continuing rTMS sessions, but gradually reducing the frequency based on the patient’s symptom response.
- Maintenance rTMS: Receiving rTMS at regular intervals, such as a single session every few weeks, or short series of sessions (“clusters”) administered monthly.
- Retreatment: Restarting a full course of rTMS sessions if depressive symptoms return.
What Does the Research Show?
Researchers identified 22 studies with original data on rTMS as a maintenance treatment for depression through a search of PubMed (up to June 2025). These studies varied considerably in design and size. This research is important as it seeks to optimize long-term outcomes for individuals receiving rTMS therapy.
Tapering: Cautiously Optimistic
One small randomized study, along with several others, suggests that tapering may help sustain improvements, particularly when the tapering schedule is adjusted based on symptom fluctuations.
Maintenance: Cluster Treatments Appear Most Promising
- Results from individual maintenance sessions were mixed, and the optimal frequency remains unclear.
- Cluster treatment, typically involving five sessions per month spread over a few days, showed the most benefits in multiple (non-controlled) studies, though comparative research is lacking.
Retreatment: Often Effective
If a patient previously responded well to rTMS, restarting treatment upon relapse was effective in most studies. Often, fewer sessions were needed for retreatment compared to the initial course, although this varied among individuals.
Current Practice in the Netherlands
Of 18 contacted institutions, 11 in the Netherlands responded to a questionnaire. The results indicated:
- Tapering and maintenance rTMS are used in a small proportion of patients.
- Retreatment upon relapse is more frequently employed.
- Institutions reported that retreatment is effective for most patients in practice.
Patient Perspectives
Patient representatives emphasized the following points:
- Discuss maintenance options proactively, ideally when the patient is experiencing improvement.
- Ensure the plan is practical and feasible, such as clustering sessions.
- Implement regular monitoring, like a monthly check-in or questionnaire, to detect relapse early.
- A strong, trusting relationship with the treatment provider is crucial for open communication.
Implications for Clinical Practice
The consensus statement recommends developing a follow-up plan collaboratively with patients after successful rTMS treatment. This plan should address ongoing monitoring, intervention triggers, and the most appropriate maintenance strategy (tapering, maintenance, or retreatment), tailored to individual risk factors, symptom patterns, treatment history, and patient preferences. The authors also highlight the demand for further research to determine the most effective long-term approach.
The consensus statement was published in March 2026 in Transcranial Magnetic Stimulation.
Source: nedkad.nl
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