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This document, titled "TMS item number rules – what the evidence suggests," discusses the rules governing access to Medical Benefits Schedule item numbers for transcranial magnetic stimulation (TMS). The rules include restrictions on TMS rebates for patients who received TMS prior to November 2021, a lifetime limit of 50 TMS session rebates, and the exclusion of maintenance TMS from rebates. The document highlights the effectiveness of TMS in treating treatment-resistant depression (TRD) and the potential for relapse in patients taking antidepressant medication. It argues for the availability of TMS for all patients, the removal of the lifetime limit on TMS sessions, and the consideration of maintenance TMS as a treatment option. [Extracted from the article]

Objectives: First, to conduct a historical review of the evidence for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder and determine a clinical algorithm. Second, to identify opportunities for research.Methods: Literature searches were conducted of the MEDLINE database, UpToDate and the Australian National University Library SuperSearch from 1 January 2000 to 30 September 2019. The search terms used were 'transcranial magnetic stimulation', 'major depressive disorder' and 'depression'.Results: There were 24 meta-analyses identified, demonstrating a clear clinical effect. Left high-frequency rTMS had the most evidence. Ideal clinical parameters and study design were explored.Conclusion: Use of rTMS for some patients with depression is justified. Open research questions include the comparative efficacy of right low-frequency and bilateral stimulation, the role of rTMS in medication-naïve patients, and maintenance of effect. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact (if any) of a course of transcranial magnetic stimulation (TMS) on irritability occurring in association with acute major depressive disorder (MDD). Method: In a naturalistic study, patients with MDD according to DSM-5 criteria were given 20 daily TMS treatments. A visual analogue scale for irritability (VAS-I) was developed. Objective tools included the six-item Hamilton Depression Rating Scale (HAMDS6) and the Clinical Global Impression - Severity (CGI-S). Results: Fifty patients received 53 courses. Forty-seven courses achieved remission on both HAMD6 and CGI-S and six courses did not achieve remission with either. Irritability significantly reduced when MDD remission was achieved but was unchanged when remission was not achieved. Conclusion: TMS reduces irritability occurring in association with MDD when this treatment affects MDD remission, but not when remission is not affected. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of clustered maintenance transcranial magnetic stimulation (TMS) on irritability occurring in treatment-resistant major depressive disorder (MDD).Method: A naturalistic study of 106 courses that includes pre- and posttreatment assessments of subjective and objective depression and a subjective measure of irritability developed for this study.Results: Forty-six participants (35 females), mean age 43.2 years (14.3), completed 106 courses. There was a significant reduction in irritability and depression scores (p < .001). The change in irritability scores was significantly correlated with the change in depression scores, r = .40, p < .001.Conclusion: TMS has the capacity to reduce the irritability co-occurring with treatment-resistant MDD, known to be responsive to TMS. This increases the possibility of using TMS in the treatment of irritability co-occurring with other disorders or standing alone (should irritability be categorized as a stand-alone disorder). [ABSTRACT FROM AUTHOR]