Practitioner perspectives on best practice in non-treatment factors that support the delivery of repetitive transcranial magnetic stimulation (rTMS) for depression.

Sharon Mallon,Kate Walker,Chris Griffiths,Zana Bayley

doi:10.1111/jpm.12815

Abstract

Accessible SummaryWhat is known about the subject? The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomesTo date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment.There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices What this paper adds to existing knowledge? This study provides unique insights into service and personalized non‐treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patientsIt reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. What are the implications for practice? The need to apply findings for the development of best practice guidanceFactors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff.

Highlights

Major depressive disorder (MDD) is a large contributor to global burden of disease (WHO, 2017)
All staff involved in the procedure at those sites who agreed to take part (n = 3) were given a letter by their line manager asking them to contact the researchers if they were interested in participating in an interview about Repetitive transcranial magnetic stimulation (rTMS) delivery
The interviewing team comprised two experienced qualitative researchers (Authors 2 and 3) one of whom works in the HE sector, and one of whom is a contract researcher within a National Health Service (NHS) setting not connected to participants

Summary

Introduction

Major depressive disorder (MDD) is a large contributor to global burden of disease (WHO, 2017). Depression carries a large cost to society through assessment, monitoring, care and treatment as well as the loss of productivity and societal contribution of those affected (Greenberg et al, 2015). Relapse rates of depression remain high (Huynh & McIntyre, 2008). Treatment-resistant depression (TRD) is considered to be no response to at least two consecutive courses of antidepressant medication (Berlim & Turecki, 2007). Between 12% and 20% of depressed patients have TRD (Nemeroff, 2007). Repetitive transcranial magnetic stimulation (rTMS) is a form of neuromodulation: a non-invasive and non-convulsive technique where a purpose‐made electromagnetic coil is placed against the

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