LONG-TERM EFFICACY OF REPEATED DAILY PREFRONTAL TRANSCRANIAL MAGNETIC STIMULATION (TMS) IN TREATMNT-RESISTANT DEPRESSION
Article first published online: 11 JUN 2012
© 2012 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 29, Issue 10, pages 883–890, October 2012
How to Cite
Mantovani, A., Pavlicova, M., Avery, D., Nahas, Z., McDonald, W. M., Wajdik, C. D., Holtzheimer, P. E., George, M. S., Sackeim, H. A. and Lisanby, S. H. (2012), LONG-TERM EFFICACY OF REPEATED DAILY PREFRONTAL TRANSCRANIAL MAGNETIC STIMULATION (TMS) IN TREATMNT-RESISTANT DEPRESSION. Depress. Anxiety, 29: 883–890. doi: 10.1002/da.21967
- Issue published online: 1 OCT 2012
- Article first published online: 11 JUN 2012
- Manuscript Accepted: 28 APR 2012
- Manuscript Revised: 2 APR 2012
- Manuscript Received: 7 FEB 2012
- National Institute of Mental Health. Grant Numbers: 5R01MH069929, 5R01MH069887, 5R01MH069896, 5R01MH069895, 5R01MH069886
- transcranial magnetic stimulation;
A few studies have examined the durability of transcranial magnetic stimulation (TMS) antidepressant benefit once patients remitted. This study examined the long-term durability of clinical benefit from TMS using a protocol-specified TMS taper and either continuation pharmacotherapy or naturalistic follow-up.
Patients were remitters from an acute double-blind sham-controlled trial of TMS (n = 18), or from an open-label extension in patients who did not respond to the acute trial (n = 43). Long-term durability of TMS acute effect was examined in remitters over a 12-week follow-up. Relapse, defined as 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20, was the primary outcome.
Of 61 remitters in the acute trial, five entered naturalistic follow-up and 50 entered the TMS taper. Thirty-two patients completed TMS taper and 1-, 2-, and 3-month follow-up. At 3-month visit, 29 of 50 (58%) were classified as in remission (HDRS-24 ≤10), two of 50 (4%) as partial responders (30%≤ HDRS-24 reduction <50% from baseline), and one of 50 (2%) met criteria for relapse. During the entire 3-month follow-up, five of the 37 patients relapsed (relapse rate = 13.5%), but four of them regained remission by the end of the study. The average time to relapse in these five patients was 7.2 ± 3.3 weeks. Patients who relapsed had higher depression scores at 1 month.
While one third of the sample was lost to follow-up, our results demonstrate that most patients contributing to observations experienced persistence of benefit from TMS followed by pharmacotherapy or no medication. Longer follow-up and more rigorous studies are needed to explore the true long-term durability of remission produced by TMS.