Real world transcranial magnetic stimulation for major depression: A multisite, naturalistic, retrospective study

•This is the largest study to evaluate the efficacy of rTMS on the dorsolateral prefrontal cortex (DLPFC) in patients with treatment-resistant depression (TRD) in real-world practice, using a standardized clinical hetero-assessment.•Data were analyzed from 435 patients with treatment-resistant depression, 26% of whom had bipolar depression.•The mean improvement was 33% (SD = 31%), the mean (SD) decrease in depression severity assessed by MADRS was 9.47 (8.73), response and remission rates were 31% and 23%, respectively.•Multivariate analyses showed a significant effect of baseline MADRS score on depression score reduction, and an association with remission with a low baseline MADRS score.•No serious adverse events or potentially predictive events (eg, seizures or maniac switching) were reported.