rTMS in Depression — MRCPsych Paper B MCQ

Correct answer: C — It may be used with normal governance and audit arrangements; short-term efficacy evidence is adequate, although clinical response varies.

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as E

B is correct. NICE HTG396 states that rTMS for depression has no major safety concerns and that evidence for short-term efficacy is adequate, although response is variable. It may therefore be used with normal arrangements for clinical governance and audit. Patients should be informed about alternatives and the possibility of receiving no benefit. NICE encourages further evidence on patient selection, maintenance treatment and long-term outcomes, but this uncertainty does not restrict rTMS to research or require special governance arrangements. NICE does not require prior failure of ECT and does not limit the procedure to bipolar depression. The guidance also covers different stimulation frequencies and unilateral or bilateral targets, so describing rTMS solely as high-frequency left dorsolateral prefrontal stimulation would be unnecessarily restrictive.

Reference: NICE. Repetitive transcranial magnetic stimulation for depression, HealthTech guidance HTG396, recommendations 1.1–1.3, 2015; migrated from IPG542 in January 2026. https://www.nice.org.uk/guidance/htg396/chapter/recommendations