Why health authorities should endorse rTMS for treatment-resistant depression
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.
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BibTeX
@article{batail2026health,
title = {{Why health authorities should endorse rTMS for treatment-resistant depression}},
author = {Jean-Marie Batail and Raphaël Gaillard and Emmanuel Haffen and Emmanuel Poulet and Anne Sauvaget and David Szekely and Jérôme Brunelin and Samuel Bulteau and Maxime Bubrovszky and Julien Smadja and Alexis Bourla and Alexis Bourla and Noomane Bouaziz and Dominique Januel and Maud Rothärmel and Charles Laidi and Martijn Arns and Jonathan Downar and Paul B. Fitzgerald and Andre R. Brunoni and Stefano Pallanti and Giordano D’urso and Jonathan Repple and Nils Opel and Debby Klooster and Odile A. van den Heuvel and Alexander T Sack and Chris Baeken and Nolan R Williams and Bruno Millet and Jean-Pascal Lefaucheur and Dominique Drapier},
journal = {Transcranial Magnetic Stimulation},
year = {2026},
month = jun,
doi = {10.1016/j.transm.2026.100321},
url = {https://hal.science/hal-05674017v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Why health authorities should endorse rTMS for treatment-resistant depression
AU - Jean-Marie Batail
AU - Raphaël Gaillard
AU - Emmanuel Haffen
AU - Emmanuel Poulet
AU - Anne Sauvaget
AU - David Szekely
AU - Jérôme Brunelin
AU - Samuel Bulteau
AU - Maxime Bubrovszky
AU - Julien Smadja
AU - Alexis Bourla
AU - Alexis Bourla
AU - Noomane Bouaziz
AU - Dominique Januel
AU - Maud Rothärmel
AU - Charles Laidi
AU - Martijn Arns
AU - Jonathan Downar
AU - Paul B. Fitzgerald
AU - Andre R. Brunoni
AU - Stefano Pallanti
AU - Giordano D’urso
AU - Jonathan Repple
AU - Nils Opel
AU - Debby Klooster
AU - Odile A. van den Heuvel
AU - Alexander T Sack
AU - Chris Baeken
AU - Nolan R Williams
AU - Bruno Millet
AU - Jean-Pascal Lefaucheur
AU - Dominique Drapier
PY - 2026
DA - 2026/06/05
JO - Transcranial Magnetic Stimulation
DO - 10.1016/j.transm.2026.100321
UR - https://hal.science/hal-05674017v1
AB - 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.
SN - 3050-5291
ER -