Prognostic factors in major depressive disorder: comparing responders and non‐responders to Repetitive Transcranial Magnetic Stimulation (rTMS), a naturalistic retrospective chart review

Abstract

Aim: Repetitive transcranial magnetic stimulation (rTMS) is widely utilized as an effective treatment for major depressive disorder (MDD) with varying response rates. Factors associated with better treatment outcome remain scarce. This naturalistic retrospective chart review hopes to shed light on easily obtainable and measurable predictive factors for patients referred to rTMS.Methods: Protocol parameters, medication, rated scales, rTMS protocols, and treatment outcomes were reviewed for 196 patients with MDD who received rTMS at Saint Boniface Hospital between 2013 and 2019. Logistic regression and marginal effects were used to assess the different predictor variables for response (50% reduction or more on the Hamilton Depression Rating Scale (Ham-D)) and remission (Ham-D of ≤7 by the last session).Results: HamD at 10 sessions was predictive of remission, and Sheehan Disability Scale (SDS) at 10 sessions was predictive of response to rTMS. Ham-D, SDS, and Beck Anxiety Inventory were predictive of remission and response by Beck Anxiety Inventory 20 sessions. High frequency rTMS had a similar response and remission rate to low frequency, but higher response rate to intermittent Theta Burst Stimulation with no difference in remission rate. Positive predictive factors of response were lower age and bupropion use. Negative predictive factors were antipsychotics, anticonvulsants, or benzodiazepine use. For remission, antipsychotics or anticonvulsants use were negative predictors; bupropion use and higher resting motor threshold were positive predictors. Severity of depression as measured by baseline HamD was not associated with different probabilities of treatment success.

Decoding complexity

“…In previous studies, higher age has been associated with non-response to various treatments, including rTMS, possibly mediated by treatment-resistance and episode recurrence, but results remain inconclusive (Carlo, Calati, and Serretti 2016;Aoun et al 2022;Figiel et al 1998;Krepel et al 2019). Our results cannot be simply explained by age, because of several factors.…”

Unilateral and Bilateral Theta Burst Stimulation for Treatment-Resistant Depression: Follow up on a Naturalistic Observation Study

“…Introducing additional rTMS methods to treat comorbid anxiety may benefit patients with TRD, as anxiolytic effects may be associated with suicidality reduction and depressive symptom remission. [24][25] However, it is also important to note that bsTBS was not found to be effective for mixed mood episodes. 26 These results suggests that clinicians need to carefully assess the phenomenological overlap between anxious depression and irritable mixed mood episodes when selecting the appropriate TRD treatment.…”

A Case Series of Intermittent Theta Burst Stimulation Treatment for Depressive Symptoms in Individuals with Autistic Spectrum Disorder: Real World TMS Study in the Tokyo Metropolitan Area

“…Furthermore, although the sample size in this case series is too small, the exploratory analyses did not find any significant effects of age or sex on the antidepressant effect of iTBS in individuals with ASD. Further research with a larger sample size is needed to examine the potential impact of benzodiazepine use on the antidepressant effect of TMS therapy, including iTBS for individuals with ASD, as benzodiazepines may reduce the therapeutic effect of TMS in the treatment of depression [ 16 , 17 , 18 , 19 ]. Additionally, as for sex differences, while males are overrepresented in the epidemiology of ASD, the proportion of male cases was more than double that of females in this case series.…”