Why health authorities should endorse rTMS for treatment-resistant depression
Year: 2026
Type: article
Abstract: Repetitive Transcranial Magnetic Stimulation (rTMS) is a widely used noninvasive brain stimulation technique that has been approved for treatment-resistant depression (TRD) in many countries. A growing divergence in national health authority positions has reignited debate over the role of rTMS in the treatment of treatment-resistant depression (TRD). While numerous countries—including the United States, Canada, and Australia—have endorsed and reimbursed rTMS based on robust meta-analytic evidence, other jurisdictions have issued more restrictive or inconclusive recommendations. These contrasting stances reflect significant variability in how health authorities interpret the clinical and cost-effectiveness data, leading to inconsistent access and coverage worldwide. This heterogeneity has sparked ongoing controversies in multiple countries, including recent policy discussions in Australia and Europe, highlighting the need for clearer, evidence-aligned guidance at the international level. The striking contrast between the evidence for efficacy of rTMS in TRD and the lack of recommendation from some national health authorities raises particularly important questions since it leads to many serious consequences from public health and medico-economic standpoints. In this article, we argue that health authority endorsement of rTMS for TRD is justified on clinical, safety, and economic grounds. We further propose that such endorsement should be linked to three prerequisites—training certification, defined therapeutic positioning, and standardized clinical protocols. Training and accreditation frameworks should be implemented at scale to facilitate the approval of rTMS by health authorities, enabling widespread, high-quality delivery, optimizing outcomes, and generating health economic returns.
Authors: Jean-Marie Batail, Raphaël Gaillard, Emmanuel Haffen, Emmanuel Poulet, Anne Sauvaget, David Szekely, Jérôme Brunelin, Samuel Bulteau, Maxime Bubrovszky, Julien Smadja, Alexis Bourla, Noomane Bouaziz, Dominique Januel, Maud Rotharmel, Charles Laidi, Martijn Arns, Jonathan Downar, Paul B. Fitzgerald, André R. Brunoni, Stefano Pallanti, Giordano D'Urso, Jonathan Repple, Nils Opel, Debby Klooster, Odile A. Van Den Heuvel, Alexander T. Sack, Chris Baeken, Nolan R. Williams, Bruno Millet, Jean-Pascal Lefaucheur, Dominique Drapier
Institutions: Centre National de la Recherche Scientifique, Institut national de recherche en sciences et technologies du numérique, Inserm, Institut de Recherche en Informatique et Systèmes Aléatoires, CIC Rennes, Centre Hospitalier Guillaume Régnier, Empenn, Université de Rennes, Université Paris Cité, Centre Hospitalier Sainte-Anne, Centre Hospitalier Universitaire de Besançon, Laboratoire de recherches Intégratives en Neurosciences et psychologie Cognitive, Université Marie et Louis Pasteur, Lyon 1 Université, Centre de Recherche en Neurosciences de Lyon, Hospices Civils de Lyon, Centre Hospitalier Universitaire de Nantes, Laboratoire Motricité, Interactions, Performance, Nantes Université, Princess Grace Hospital Centre, methodS in Patient-centered outcomes and HEalth ResEarch, Etablissements de Santé Mentale, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Hôpital Saint-Antoine, Institut du Cerveau, Hôpital de Ville-Évrard, Université Sorbonne Paris Nord, Centre Hospitalier du Rouvray, Hôpitaux Universitaires Henri-Mondor, Brainclinics, Centre for Addiction and Mental Health, University of Toronto, Australian National University, Universidade de São Paulo, Albert Einstein College of Medicine, University of Campania "Luigi Vanvitelli", Goethe University Frankfurt, University of Münster, University Hospital Frankfurt, Deutsches Zentrum für Psychische Gesundheit, Charité – Universitätsmedizin Berlin, Kempenhaeghe, Eindhoven University of Technology, Amsterdam Neuroscience, Amsterdam University Medical Centers, Maastricht University, Vrije Universiteit Brussel, Ghent University, Universitair Ziekenhuis Brussel, Stanford University, Université Paris-Est Créteil
Language: English
Subfield: Neurology
Field: Neuroscience
Domain: Life Sciences
Open Access status: hybrid
Estimated APC paid: $2,500
OpenAlex ID: W7163644969