A naturalistic study of transcranial magnetic stimulation (TMS) in major depressive disorder

Background: TMS is effective in the treatment of major depressive disorder (MDD) in placebo-controlled trials and naturalistic out-patient studies. In Australia, TMS receives no rebate (currently), thus, privately insured patients generally receive this treatment as inpatients.

Aim: A naturalistic study of the effects of TMS on depressive episodes of MDD in private hospital inpatients, to determine whether TMS is effective in severe depression, and whether age or gender impact on outcome.

Method: - and post-treatment HAMD6, visual analogue scale (VAS6) for depression, and CGI-S. In addition, a mid-treatment VAS6. Patients were grouped according to HAMD6 severity (mild, moderate, severe). Treatment: daily, 10 Hz, 4 second trains, a total of 75 trains at 110% resting motor threshold applied to the LDLFC. A course of treatment - 20 daily sessions over 26 days. Repeated measures ANCOVA were used to understand the impact of time, gender and age on depression levels.

Results: 52 patients with MDD participated – 35% had previously received TMS. Overall, 69% achieved remission – including 63.2% (12/19) of those with severe depression. Neither age nor gender impacted on outcome.

Conclusion: A naturalistic inpatient study of TMS treatment of MDD produced remission in 69% of 52 patients – including 63.2% (12/19) with severe depression. As 35% of patients had received TMS previously, the results were better than might otherwise be expected. Neither age nor gender impacted on outcome.