In September 2017, PMDA approved the NeuroStar TMS treatment apparatus for treatment of major depressive disorder (MDD). Clinical guidelines for the proper use of rTMS were made thereafter. The aim of this article is to support understanding of the guidelines and to convey points of concern regarding the application of rTMS therapy. We explained the process of rTMS therapy in six steps: 1. How to decide whether to match the criteria for rTMS therapy, 2. Informed consent, 3. Preparations prior to rTMS sessions, 4. How to set the stimulation conditions, 5. Evaluation of the effectiveness and safety during rTMS sessions, and 6. When to suspend rTMS therapy. We presented two MDD patients, one was a remitter and the other was a non-responder, who underwent rTMS therapy at Kanagawa Psychiatric Center. Precise diagnosis and evaluation of the severity of MDD is important for satisfactory rTMS.
 <Authors' abstract>