A 6-month follow-up study on response and relapse rates following an acute trial of repetitive transcranial magnetic stimulation in patients with major depression

Abstract

Background Little is known about the post-acute effects of repetitive transcranial magnetic stimulation (rTMS) in patients with major depression. The present study focused on the 6-month follow-up of a sample of patients with major depression, after the completion of an acute 4 weeks rTMS trial, with the aim of evaluating response (in terms of sustained and late response) and relapse rates. Methods Following the completion of an acute trial of rTMS (T0-T4), 31 drug-resistant depressed patients (bipolar or unipolar) entered a naturalistic follow-up period of 6 months, with three timepoints (T5, T6, and T7) during which they were assessed with the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Results Results showed that in the 6 months following an acute transcranial magnetic stimulation (TMS) trial, a higher rate of late responders was observed among previously acute TMS nonresponders (63.64%, 7 out of 11) compared to the rate of relapse among those who had acutely responded to TMS (10%, 2 out of 20). In addition, an overall high rate of maintained response (90%) was observed. Conclusion Present findings seem to support the possibility of obtaining a clinical response also after the end of an acute TMS trial in patients with major depression. The concomitant low rate of relapse observed at the end of follow-up along with a high rate of maintained response provides further support to the post-acute efficacy of TMS. Nonetheless, further controlled studies, with larger samples and longer follow-up observation, are needed to confirm the reported results.

Investigating the Role of Maintenance TMS Protocols for Major Depression: Systematic Review and Future Perspectives for Personalized Interventions

“…It has been noted that the antidepressant effects of TMS were not limited to the acute treatment period, but a considerable number of patients (up to 63%) showed a response even weeks or months after. Additionally, post-acute treatment relapse risk was very low in the first month [19]. In this context, maintenance starting before this period and close to acute treatment could overlap with active protocol efficacy, hence suggesting a possible superfluous treatment.…”

“…A recent study on this matter pointed out that a significant portion of patients (up to 63%) does not respond to acute rTMS protocols immediately but rather shows a delayed response [19]. This finding suggests that the mechanisms underlying magnetic stimulation are complex and involve changes that occur over time.…”

Short-term and long-term efficacy of accelerated transcranial magnetic stimulation for depression: a systematic review and meta-analysis

“…Arici et al reported that after rTMS treatment of patients with MDD for a total of 20 sessions over 4 weeks, 90% of those who responded remained responsive during a 6-month follow-up period [ 44 ]. According to meta-analysis of the durability of rTMS, high-frequency rTMS had a slight antidepressant effect at short-term follow-up [ 45 ].…”

“…Fourth, the follow-up periods were short, ranging from 3 weeks to 3 months. In a follow-up study of standard TMS for depression, a good antidepressant effect was still observed at 6 months [ 44 , 55 ]. ATMS appears to have similar long-term effects.…”

Short-term and long-term efficacy of accelerated transcranial magnetic stimulation for depression: A systematic review and meta-analysis

“…Arici et al found that after rTMS treatment of patients with MDD for a total of 20 sessions over 4 weeks, 90% of those who responded remained responsive during a 6-month follow-up period [21]. The metaresults on the durability of repetitive transcranial magnetic stimulation also showed that high-frequency rTMS continued to have a small antidepressant effect at short-term follow-up [22].…”