Repetitive transcranial magnetic stimulation effective in major depression

Repetitive transcranial magnetic stimulation was effective in routine treatment of medication-resistant major depression, according to findings published in the Journal of Affective Disorders.

“Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation technique which has demonstrated antidepressant properties via innovative mechanisms without the side effects of pharmacological antidepressants or electroconvulsive therapy,” Noomane Bouaziz, MD, of the clinical research unit at Etablissement Publique de Santé Ville-Evrard in Neuilly-sur-Marne, France, and colleagues wrote.

“The clinical benefits of rTMS, in terms of response and remission rates, have varied in randomized controlled trials (RCTs),” they continued. “Subjects included in RCTs are rarely representative of real-world patient populations due to the application of strict selection criteria aiming to avoid comorbidities, the risk of suicide and confounding variables.”

Bouaziz and colleagues retrospectively analyzed data from 435 adult patients with major depressive disorder (MDD) who received rTMS at five university hospitals in France from 2015 to 2020.

Participants completed either the Montgomery and Asberg Depression Rating Scale (MADRS) or the Hamilton Depression Rating Scale (HDRS) to evaluate severity of depression symptoms before and after rTMS. Because more participants completed the MADRS, the researchers converted HDRS scores to MADRS. Treatment response was defined as a decrease of at least 50% in MADRS score.

Most participants were women (65%), with a mean age of 51.27 years. Bipolar disorder was prevalent in 26% of patients. The majority of participants (n = 274; 63%) were using antidepressants at baseline, most commonly with benzodiazepines (n = 220; 50.8%).

Among 344 participants with information on psychiatric comorbidities, 239 (69.48%) had at least one, with anxiety being most common (50%). There were 77 (23.19%) patients with at least one somatic comorbidity among 332 patients with information on these comorbidities; the most common was cardiovascular disease (10.24%).

Treatment frequencies for rTMS ranged from 1 Hz to 50 Hz. There was an average of 10.63 to 27.87 sessions, with an average of 12,300 to 45,043 total pulses delivered, respectively.

Overall, participants had a mean improvement of 33% with a mean decrease in MADRS of 9.47. The average response rate was 31% (range, 22%-57% across sites), and the average remission rate was 22.8% (range, 16%-50% across sites).

Compared with participants who had moderate depression, those with severe depression had a greater change in MADRS (P < .001).

Change in MADRS was greater among patients without vs. with psychiatric comorbidities (P = .019); there were no differences between patients with vs. without somatic comorbidities.

“Our study adds to real-world evidence of rTMS efficacy, which leads to questions as to why it is used as a second- or third-line depression treatment, despite its safety, its increasing availability and its cost effectiveness,” Bouaziz and colleagues wrote.

Moving forward, they suggested research should focus on optimization and personalization of rTMS.