Accelerated repetitive transcranial magnetic stimulation in the treatment of depression

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is increasingly used clinically in the treatment of patients with major depressive disorder (MDD). However, rTMS treatment response can be slow. Early research suggests that accelerated forms of rTMS may be effective but no research has directly evaluated a schedule of accelerated rTMS compared to standard rTMS. To assess the efficacy of accelerated rTMS compared to standard daily rTMS., 115 outpatients with MDD received either accelerated rTMS (n = 58) (i.e., 63,000 high frequency rTMS pulses delivered as 3 treatments per day over 3 days in week 1, 3 treatments over 2 days in week 2 and 3 treatments on a single day in week 3) or standard rTMS (n = 57) (i.e., 63,000 total high frequency rTMS pulses delivered over 5 days per week for 4 weeks) following randomization. There were no significant differences in remission or response rates (p > 0.05 for all analyses) or reduction in depression scores (Time by group interaction (F (5, 489.452) = 1.711, p = 0.130) between the accelerated and standard rTMS treatment groups. Accelerated treatment was associated with a higher rate of reported treatment discomfort. It is feasible to provide accelerated rTMS treatment for outpatients with depression and this is likely to produce meaningful antidepressant effects.

Conflict of interest statement

In the last 3 years PBF has received equipment for research from Magventure A/S, Medtronic Ltd, Neurosoft and Brainsway Ltd. He has served on a scientific advisory board for Bionomics Ltd and LivaNova. In the last 3 years, ZJD has received research and equipment in-kind support for an investigator-initiated study through Brainsway Inc and Magventure Inc. The remaining authors declare that they have no conflict of interest.

Figures

Fig. 1

CONSORT diagram for study

Fig. 2

Montgomery Asberg depression rating scale (MADRS) scores across study timepoints

Fig. 3

The distribution of response (change in Montgomery Asberg depression rating scale (MADRS) scores from baseline to 8 week follow-up for the two treatment groups

Fig. 4

Montgomery Asberg depression rating scale (MADRS) scores across study timepoints for the responders only (defined as a greater than 35% reduction in MADRS scores from baseline to week 8)