Ethical Considerations Regarding the Use of Transcranial Magnetic Stimulation in Mental Health Practice

Ethical considerations regarding the use of transcranial magnetic stimulation (TMS) have been discussed from the start of its application for clinical and research purposes ( 1 Rossi S. Hallett M. Rossini P.M. Pascual-Leone A. Safety of TMS Consensus GroupSafety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009; 120: 2008-2039 Crossref PubMed Scopus (3719) Google Scholar , 2 Illes J. Gallo M. Kirschen M.P. An ethics perspective on transcranial magnetic stimulation (TMS) and human neuromodulation. Behav Neurol. 2006; 17: 149-157 Crossref PubMed Scopus (26) Google Scholar ). Recent changes to the TMS landscape merit revisiting those initial considerations. These changes include novel devices, new protocols (e.g., different stimulation parameters as well as accelerated bursts of stimulation), and combinations of TMS with brain imaging techniques (including neurophysiological) and adjuvant treatment modalities. The clinical indications of TMS have expanded in the last decade. For example, in the United States, repetitive TMS (rTMS) for the treatment of mental health indications was cleared by the U.S. Food and Drug Administration in 2008 to treat depression; later (in 2019) it was cleared for the treatment of obsessive-compulsive disorder; in 2020 as an aid in short-term smoking cessation; and more recently, in 2021, for anxiety (co-occurring with depression).