There is a wealth of evidence for TMS developed over 20 years which allowed it to be reimbursed by Medicare for depression.
- TMS has a wealth of evidence and clinical papers developed over 20 years, mostly by individual researchers. There are more trials that are not sponsored by drug or machine companies on TMS than most antidepressants
- It is endorsed by the Royal Australian New Zealand College of Psychiatrists (RANZCP) and reimbursed by Medicare because of it's strong evidence base (RANZCP 2018)
- Evidence suggests that:
- TMS is a safe, effective and well tolerated depression treatment that approximately 2/3 depression patients will respond to and 1/3 depression patients will go into remission (Carpenter et al 2012)
- It is effective beyond placebo (Berlim et al 2013)
- After reviewing the evidence, Medicare determined that there was enough evidence on the effects of TMS in medication resistant depression to fund the treatment (MSAC 2020)
- Much of the research nowadays is less around proving that TMS works and more around determining how we can improve the benefits of TMS.
RANZCP - TMS Position Statement
The RANZCP state that "rTMS is a therapeutic, well tolerated, and safe, medical procedure for the treatment of psychiatric disorders, especially episodes of major depression" and that "there is a good evidence base for the therapeutic efficacy of rTMS in major depressive disorder" (RANZCP 2018).
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is responsible for training, educating and representing psychiatrists in Australia and Aotearoa New Zealand.
Meta Analysis of randomised, double-blind, sham-controlled trial (RCT)
Multiple meta analyses of RCTs indicate that TMS is an effective treatment for depression beyond placebo (Berlim et al 2013).
| Study | Response | Remission | Patient numbers | Number of trials |
| Berlim et al 2013 | 62% | 53% | 392 | 6 |
Randomised, double-blind sham-controlled trials are considered the gold standard in determining if the treatment works beyond placebo. This involves a group of patients being split into 2, with one group receiving live treatment while the other receives a placebo. Neither the researcher nor the patient knows if they are receiving live or placebo treatment.
For TMS a special coil was developed that mimics the noise and feeling of TMS without administering treatment. The coil might also be angled in a slightly different area so it is not targeting the right part of the brain.
Meta analyses combines the results of studies to generate a larger number of trial patients to report on.
Naturalistic trial
Naturalistic trials support the RCTs in determining that TMS is a safe and effective depression treatment.
| Study | Response | Remission | Patient numbers |
| Carpenter et al 2012 | 58% | 37.1% | 307 |
A naturalistic trial is a type of trial that studies the effects of a treatment in real world scenarios rather than in a research environment.
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