Repetitive Transcranial Magnetic Stimulation (rTMS) in Treatment Resistant Depression: Retrospective Data Analysis from Clinical Practice

Abstract

Objective: The aim of this paper is to present the service data results from a clinical repetitive Transcranial Magnetic Stimulation (rTMS) service treating treatment resistant depression (TRD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving rTMS between 2015 and 2018. Measures used were the clinician-rated Clinical Global Impression (CGI) and Hamilton Depression Rating Scale (HAM-D), and patient rated Physical Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7). The outcome data of 144 patients with TRD was analysed. The sample included patients with co-morbid psychiatric diagnosis. Results: Response and remission rates respectively were 34.6% and 20.6% for the HAM-D; 10% and 28.6% for the PHQ-9; 31% and 31.8% for the CGI; and 24.6% and 28.8% for GAD-7. Effect sizes were mostly medium (0.48, 0.27, 0.51, 0.43 respectively). GAD-7 reliable change improvement was 56.1% and PHQ-9 reliable change improvement was 40%. There was a medium positive correlation between anxiety (GAD-7) and depression recovery (HAM-D), r = 0.31, n = 46, p = 0.039, with lower pre-treatment anxiety associated with lower post-treatment HAM-D scores. Conclusions: TRD patients with low pre-treatment anxiety levels respond to treatment better than those with high pre-treatment anxiety. The results show that a clinical rTMS service can have a significant impact on symptoms of depression and anxiety in TRD. The findings support wider availability of rTMS as a treatment option for people with TRD.

Investigation of physical activity, sleep, and mental health recovery in treatment resistant depression (TRD) patients receiving repetitive transcranial magnetic stimulation (rTMS) treatment

“…The anxiety outcome results show that rTMS treatment in a clinical service can be effective in treating GAD symptoms in TRD patients. This supports the results of other published papers ( Diefenbach et al., 2013 ; LaSalle-Ricci et al., 2014 ; Caulfield et al., 2016 ; White and Tavakoli, 2015 ; Griffiths et al., 2019a ). However, there is currently a lack of RCT evidence on the effectiveness of rTMS on GAD in depression, and further well-designed and adequately powered RCTs are required to determine clinical recommendations ( Kozel, 2018 ).…”

“…The effect sizes observed from Wilcoxon signed-rank significance tests on pre-post mental health assessments exceed those previously reported in the same the rTMS service ( Griffiths et al., 2019a ); see Table 2 .…”

“…Peer-reviewed published studies reported remission and therapeutic response in clinical service settings ranging between 29% - 51% and 6% - 37%, respectively (Carpenter et al., 2012; Connolly et al., 2012; Galletly et al., 2015; Taylor et al., 2017). In the rTMS service that was the recruitment centre for the present study, the reported response and remission rates, respectively, were 10% and 28.6% for depression (effect size = 0.27); and 24.6% and 28.8% for generalised anxiety disorder (effect size = 0.43) (GAD) ( Griffiths et al. 2019a ).…”

Efficacy of Deep TMS with the H1 Coil for Anxious Depression

“…These studies have used a variety of stimulation protocols reflecting the on-going search for the ideal protocol for the treatment of MDD with TMS. These protocols include high frequency-left dlPFC [21,22], low-frequency right dlPFC [23], and bilateral [24,25]. However, the clinical value of these studies is reduced by the lack of placebo arms.…”

A Retrospective Naturalistic Study Comparing the Efficacy of Ketamine and Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression

“…The χ 2 test was used to compare responders and remitters between the two groups. Responders were defined as patients with a 50% or greater decrease on the post treatment scores from the pre-treatment scores and remitters were defined as patients with HDRS post score ≤7, HAM-A ≤7 and BDI-II ≤13 ( 50 – 52 ). Mixed factorial ANOVAs were conducted to investigate the effect of both the within factor (Time) and the between factor (Experimental group).…”