TMS offers similar benefit for MDD patients with and without comorbid PTSD

Patients with PTSD had similar levels of major depressive disorder response and remission with transcranial magnetic stimulation, or TMS, as patients without PTSD, according to study findings published in Journal of Clinical Psychiatry.

“The primary goal of this study was to identify possible prognostic factors associated with treatment response for patients undergoing TMS,” Michael J. Hernandez, MD, of James A. Haley Veterans’ Hospital, and colleagues wrote. “We assessed whether, similar to the findings of [a prior study], patients with comorbid MDD and PTSD would have significantly different outcomes compared [with] patients with MDD but no PTSD. We anticipated that, as in patients with MDD treated with medication, comorbid anxiety would predict a lower likelihood of response or remission compared [with] absence of comorbid anxiety.”

The investigators also evaluated whether the use of concomitant neuropsychiatric medications while undergoing TMS affected patients’ outcomes or treatments’ tolerability. To achieve these aims, they analyzed a quality database to compare outcomes of MDD treated with TMS among veterans with and without comorbid PTSD. They included the clinical outcomes of all veterans with MDD who were treated at a single hospital from October 2013 through September 2018. A psychiatrist initially evaluated patients who were diagnosed with MDD per DSM-IV-TR/DSM-5 criteria. Patients were assessed with clinician-rated scales of depression and self-reported at the start of treatment, after every five treatments and at the end of treatment.

Results showed that 55 (47%) of 118 patients treated with TMS for depression had comorbid PTSD and 63 (53%) had no comorbid PTSD. According to Montgomery-Asberg Depression Rating Scale scores, response and remission rates were 52.5% and 40.9%, respectively, for patients with PTSD and 53.8% and 35.6%, respectively, for patients without PTSD, which the researchers considered similar. No persistent adverse effects or seizures were reported in either group.

“Analysis of this quality database supports TMS as an effective treatment for MDD in veterans with and without comorbid PTSD,” Hernandez and colleagues wrote. “Increasing age may actually be a positive predictor of clinical TMS outcome for MDD using current treatment parameters. Anxiety appears to negatively predict response to treatment, which may require adjustment of treatment parameters. The use of lamotrigine during TMS did not result in any adverse effects, though future research with a greater number of participants is necessary to further describe the potential effects of lamotrigine on TMS.”