Early relapse (ER) transcranial magnetic stimulation (TMS) in treatment resistant major depression

Background: There is interest in using TMS to keep patients with severe relapsing depression as well as possible, once remission has been achieved. This has been conceptualized as ‘maintaining’ the remission. One protocol employs series of 5 TMS sessions over 3 or 5 days, at about monthly intervals. We have suggested this practice is better conceptualized as early relapse (ER) TMS.

Aim: To determine whether 5 TMS sessions at about monthly intervals are effective in keeping patients relatively well, and whether the concept of ER-TMS can be supported.

Method: Prospective, naturalistic, 10-month study, administering pre- and post-TMS series, HAMD6, visual analogue scale for mood, and CGI-S.

Results: Thirty-nine patients (72% female) received 168 series of 5 TMS sessions and remained in the program for 21 weeks on average. Pre-post-treatment scores showed significant reductions on all measures. Post-series HAMD6 score 3.30 (2.28) indicates remission has been achieved. Pre-series scores of 6.24 (2.78) indicate a post-series decline in mood, in the direction of relapse. Before TMS series 70% were no longer in remission (being in partial remission or relapse), and after TMS series, 79% were in remission.

Conclusion: In severe relapsing depression, monthly series of TMS move mood from the relapse/partial remission range in the direction or remission and is appropriately termed early relapse ER-TMS. Long-term availability of ER-TMS to patients with severe relapsing depression deserves consideration.