Long-Term Efficacy of Repeated Daily Prefrontal Transcranial Magnetic Stimulation (TMS) In Treatmnt-Resistant Depression

Abstract

Background-A few studies have examined the durability of transcranial magnetic stimulation (TMS) antidepressant benefit once patients remitted. This study examined the long-term durability

Cost-Effectiveness of Repetitive Transcranial Magnetic Stimulation versus Antidepressant Therapy for Treatment-Resistant Depression

“…Studies, however, have reported information on worsening and relapse rates for rTMS [6,19], antidepressants [17], and ECT treatment [20]. These rates were converted to probabilities of losing remission (regressing).…”

DURABILITY OF THE ANTIDEPRESSANT EFFECT OF THE HIGH-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) IN THE ABSENCE OF MAINTENANCE TREATMENT IN MAJOR DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 16 DOUBLE-BLIND, RANDOMIZED, SHAM-CONTR

“…The current results suggest that more rTMS sessions (10)(11)(12)(13)(14)(15) in the acute treatment phase might facilitate the durability of response to rTMS. More sessions (15ࣘ) have also been reported as important for acute remission [55] and have been routinely used in RCTs over the last 4 years.…”

“…In clinical settings, rTMS appears to have clinically meaningful longer term effects when combined with antidepressant medications and/or the reintroduction of rTMS. [12,13,52] A higher reduction in depression scores during follow-up was associated with shorter illness duration, outpatient status (possibly denoting lower illness severity), and unipolar, nonpsychotic depression. Data from open-label studies and double-blind RCTs suggest that younger patients with depression respond better to rTMS acutely [53] and in the longer term.…”

“…This is because the primary RCTs assessing the durability of rTMS response are often conducted on a low number of patients and/or the retention rates during the follow-ups are low compared to the number of patients entering the studies. [12,13] Furthermore, the longer term results of the largest shamcontrolled RCTs to date are noncomparable because of heterogeneous follow-up designs that included either a lack of active stimulation after the acute phase or open-label rTMS administration to nonrespondents and/or sham patients. Compared to studies in which no rTMS was administered during the follow-up period, the longer term effect of rTMS after open-label extensions could be confounded by placebo effects.…”

The use of transcranial magnetic stimulation as a treatment for movement disorders: A critical review

“…The other two trials showed positive results, that is, 3 to 6 weeks of daily (weekdays only) high‐frequency rTMS over the left DLPFC improved clinical outcomes significantly more than placebo . In 2008, the Food and Drug Administration approved the first TMS device for therapeutic clinical use in drug‐resistant depression, and since then several other studies further confirmed its effectiveness in clinical practice . Moreover, several meta‐analyses have reported that the sham‐controlled evidence base for the use of TMS in depression is clinically and statistically significant .…”