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It's D. TMS has been shown to be effective in “real-world” patients with treatment-resistant depression.

Explanation: Studies of TMS in real-world clinical practice settings have highlighted its effectiveness in patients with treatment-resistant depression (option D). In addition, industry-independent clinical studies have demonstrated that left prefrontal TMS daily for 3 to 6 weeks has antidepressant effects that are significantly greater than sham and that these effects are clinically meaningful (option C) (30% remission rate). Even more important, the outcomes are at least as robust as those for the next-best choice of antidepressant medication; the procedure was found to be safe and well tolerated, with a low incidence of treatment discontinuation (option E); and the therapeutic effects, once obtained, are reasonably durable.

Effect sizes for left prefrontal TMS are of similar or greater magnitude compared with those observed with the majority of currently approved antidepressant medication treatments (option B). The estimated risk of seizure associated with TMS under ordinary clinical use is approximately 1 in 30,000 treatments (0.003% of treatments) or 1 in 1,000 patients (0.1% of patients). This risk is less than or comparable to the risk of seizure associated with antidepressant medications (option A).

Muskin PR and Dickerman AL, eds. Study Guide for the Psychiatry Board Examination. Arlington, VA: American Psychiatric Association Publishing; 2016: 63, 285-286. Click here to purchase. Members can purchase at a discount.