An open label trial of clustered maintenance rTMS for patients with refractory depression

Whilst the antidepressant properties of repetitive transcranial magnetic stimulation treatment (rTMS) have been repeatedly demonstrated, minimal research has investigated the use of rTMS to prevent relapse in patients who have responded to treatment. To address this issue, a large open label trial of a new form of clustered maintenance rTMS was conducted. Thirty-five patients with treatment resistant depression were included. All patients had responded to two courses of rTMS treatment for depression. Following their second course of rTMS, they received clustered maintenance rTMS which involved monthly maintenance sessions of five rTMS treatments over a two day period. The time to relapse and clinical characteristics are described. Twenty-five patients experienced a relapse within the study period, with a mean treatment duration of 10.5 ± 10.3 months. This was substantially longer than their period of wellness following their initial acute treatment without maintenance (<3 months). Ten additional patients continued maintenance until withdrawal from the study without having experienced relapse (4 at a mean of 6.2 ± 4.3 months) or until study end (6 patients with mean duration of 12.0 ± 9.7 months). Although preliminary, this study suggests that clustered maintenance rTMS has the potential to substantially delay the occurrence of relapse following a successful course of rTMS treatment.