Background: Patients recovering from COVID-19 often suffer long-term Long-COVID (e.g., depression, poor concentration, anxiety, sleep disturbances, and fatigue). Similar symptoms also rarely seem to occur after COVID-19 vaccination. There is still no effective treatment for these symptoms. We have had a clinical experience that patients presenting with psychiatric/physical symptoms due to COVID-19 or COVID-19 vaccination (defined as Long-COVID and Post-Vaccine patients) often recover after transcranial magnetic stimulation (TMS) and that TMS poorly heals depression in strongly fatigued patients. Aims: 1. Determine whether there are differences in background characteristics and symptoms between Long-COVID and Post-Vaccine patients; 2. Examine whether TMS led to an improvement in their symptoms; 3. Test the involvement of fatigue in the recovery of depression of Long-COVID and Post-Vaccine patients with TMS. Methods: We conducted a retrospective analysis using the medical records of the outpatient clinic of Tokyo TMS Clinic. Results: 1. We found no differences in initial symptoms and courses of treatment between Long-COVID and Post-Vaccine patients. 2. All psychiatric/physical symptom scores after TMS were significantly better than before. Though these results are of before-and-after studies, numerous reports have suggested that TMS effectively improves depression, insomnia, anxiety, and related neuropsychiatric symptoms, which were also primary complaints of patients in this study. We thus attributed the improvement in QIDS, PHQ9 (Both indices of depression), and GAD7 (anxiety indicator) to TMS. 3. The recovery rate of depression in Long-Covid and Post-Vaccine patients with TMS decreased with the severity of fatigue. Conclusions: This is the first report to elucidate the efficacy of TMS and the factors affecting it for psychiatric symptoms after COVID-19 and COVID-19 vaccination. Our study may lead to further validation of the effectiveness and mechanisms of TMS in patients suffering from Long-COVID and COVID-19 vaccine long-term adverse reactions.

COVID-19’s long-term effects, known as Long-COVID, present psychiatric and physical challenges in recovered patients. Similarly, rare long-term post-vaccination side effects, resembling Long-COVID, are emerging (called Post-Vaccine). However, effective treatments for both conditions are scarce. Our clinical experience suggests that transcranial magnetic stimulation (TMS) often aids recovery in Long-COVID and Post-Vaccine patients. However, its effectiveness is reduced in patients with severe fatigue. Therefore, we retrospectively analysed Tokyo TMS Clinic’s outpatient records (60 in total; mean age, 38 years) to compare Long-COVID and post-vaccine patients’ characteristics and symptoms, assess the impact of TMS on their symptoms, and investigate the role of fatigue in depression recovery with TMS. The primary outcome was the regression coefficient of the initial fatigue score on depression score improvement using TMS. Secondary outcomes included psychiatric/physical scores before and after TMS and their improvement rates. We found no differences in the initial symptoms and background factors between Long-COVID and Post-Vaccine patients. After ten TMS sessions, all psychiatric and physical symptom scores improved significantly. TMS improves depression, insomnia, anxiety, and related neuropsychiatric symptoms, which were the primary complaints in this study. Thus, we conclude that TMS improves depression and anxiety. The effectiveness of TMS in treating depression in Long-COVID and Post-Vaccine patients decreased as fatigue severity increased. In conclusion, TMS relieved depressive symptoms following COVID-19 and vaccination; however, fatigue may hinder its effectiveness.