Objective: Repetitive transcranial magnetic stimulation (rTMS) is FDA cleared for the treatment of major depressive disorder (MDD) unresponsive to pharmacological treatment. This retrospective outcome study was designed to evaluate the efficacy of rTMS in patients stratified by symptom severity as defined by the BDI, PHQ-9, and the IDSSR30.
Methods: 250 patients with a primary diagnosis of MDD received Neurostar rTMS treatment. A retrospective chart review focusing upon response and remission rates was undertaken. Scores were normalized using conversion tables. Intervention: rTMS utilizing the Neurostar TMS Therapy System. Patients were assessed pre- and post-treatment utilizing the BDI and/or IDSSR30. Response and remission rates were evaluated retrospectively to assess post and acute phase efficacy and safety.
Results: 140 females and 110 males, with a median age of 48, were treated with rTMS. Number of sessions ranged from 20 to 30. Mean pretreatment BDI ranged from 24 to 35. Range of average medication trials in the current episode ranged 3.7 to 5.5. Patient with moderate to low baseline symptoms scores showed a response and remission rate of 77% and 65%, respectively. Patient with severe or greater symptoms scores showed response and remission rate of 52% and 38%, respectively.
Conclusion: In 4 private practice settings rTMS demonstrates clinical efficacy for symptoms of MDD in patients with low to severe symptoms. Those with less severe symptoms responded better than those with higher symptom severity. Based upon this meta-analysis and the STAR*D data, TMS therapy should be considered earlier in the depressive episode.