Can Medication Free, Treatment-Resistant, Depressed Patients Who Initially Respond to TMS Be Maintained Off...

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Trials

Background:

• Repetitive transcranial magnetic stimulation (TMS) is effective for acute treatment of treatment-resistant major depressive disorder (MDD).
• Limited data exists on the efficacy of maintenance TMS following acute response in MDD patients.

Purpose of the Study:

• To investigate 12-month outcomes of two maintenance TMS strategies: scheduled monthly sessions (SCH) versus observation only (OBS).
• To assess the feasibility of maintaining major depressive disorder (MDD) patients off antidepressants using periodic TMS.

Main Methods:

• A randomized, open-label, multisite trial involving antidepressant-free patients with treatment-resistant MDD.
• Patients achieving acute response were randomized to SCH or OBS; TMS reintroduction was permitted for symptom worsening.
• All participants remained medication-free throughout the study duration.

Main Results:

• Of 49 randomized patients, no significant group differences were observed in primary outcome measures.
• Scheduled TMS (SCH) showed a nonsignificant trend towards a longer time to first TMS reintroduction (91 days) compared to observation (OBS) (77 days).
• A high response rate (78% SCH, 63% OBS) was observed upon TMS reintroduction, indicating sustained efficacy.

Conclusions:

• Maintaining patients with treatment-resistant depression off medication using periodic TMS is feasible for some individuals.
• While not statistically significant, scheduled maintenance TMS demonstrated a trend towards delaying relapse compared to observation.
• Patients who initially respond to TMS possess a strong probability of re-responding if relapse occurs, highlighting the potential for long-term management.