The mood log – A tool for clustered maintenance TMS

Transcranial magnetic stimulation (TMS) is a safe and effective treatment of treatment resistant major depressive disorder (MDD). However, MDD is a chronic disorder and relapse is common. The leading method of managing those cases of MDD who respond to TMS, but continue to relapse, is to provide maintenance TMS – short courses of 5 treatments over 2.5 days, repeat at monthly (or greater) intervals. The strategy is to increase the interval between treatment clusters and for patients to be discharged when they have been able to remain well for a couple of months. However, patients and doctors are both frequently apprehensive about increasing the between cluster interval, and patients tend to remain in treatment programs for long periods. We present a protocol and instrument to assist in moving from treatment to discharge, which we have found helpful.