A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period.
Level 4 - case-series / case-control
Prospective, multicenter observational cohort study without a control group
PubMed 25271871 · doi:10.4088/JCP.13m08977
What was done
A prospective, naturalistic observational study across 42 clinical practices assessed the 12-month durability of acute transcranial magnetic stimulation (TMS). A total of 257 adult patients with treatment-resistant, unipolar, nonpsychotic major depressive disorder (DSM-IV criteria) who completed acute TMS were followed for 52 weeks with assessments at 3, 6, 9, and 12 months. Primary outcome was the Clinical Global Impressions-Severity of Illness scale (CGI-S), alongside the 9-Item Patient Health Questionnaire (PHQ-9) and the Inventory of Depressive Symptoms-Self Report (IDS-SR). Patients received continuation antidepressant pharmacotherapy and access to TMS retreatment.
What was found
Reductions from pre-TMS baseline in mean total scores on the CGI-S, PHQ-9, and IDS-SR were statistically significant at the end of acute treatment and remained sustained through 12 months (all P < .0001). The proportion of remitters at acute conclusion remained similar at the 12-month endpoint. Of the 120 patients who met IDS-SR response or remission criteria at acute endpoint, 75 (62.5%) continued to meet response criteria throughout long-term follow-up. After the initial post-acute month, 93 patients (36.2%) received reintroduction of TMS, averaging a mean (SD) of 16.2 (21.1) retreatment days.
Why it matters
This study shows that symptomatic improvements from TMS for pharmacoresistant depression can persist for up to a year in naturalistic clinical settings when supported by maintenance pharmacotherapy and targeted retreatment.
Limits
The absence of a sham or active control group prevents separating true TMS durability from placebo effects or natural disease fluctuation. Estimates of durability are confounded by concurrent continuation antidepressant medications and TMS retreatment in 36.2% of participants. Enrollment was restricted to patients completing acute treatment, introducing selection bias.
Cited by
- contradicts Transcranial magnetic stimulation (TMS) outcomes for depression show high relapse rates and lack durability beyond 6 months.