The durability of response to transcranial magnetic stimulation in veterans with major depressive disorder

Transcranial Magnetic Stimulation (TMS) has established efficacy for treatment resistant major depressive disorder (MDD-TR). Information on the durability of response to TMS for MDD-TR, particularly in the Veteran population, is limited. The current study aimed to address this gap in the literature by examining the durability of response to TMS for MDD-TR in Veterans.

Retrospective cohort analysis examining Veterans receiving TMS treatment for MDD-TR at a large academic VA medical center. For the primary endpoint, a composite marker termed Significant Psychiatric Events Associated with Relapse (SPEAR) consisting of mental health hospitalization, suicide attempt, death by suicide, or requirement for additional neuromodulation interventions, was utilized to assess relapse. Secondary endpoints included examining post-TMS changes in psychopharmacological regimens as a marker for relapse. Associations between covariates of interest and improved durability of response were analyzed.

Study cohort consisted of 217 Veterans, of whom 159 had the required assessments and were included in analyses. TMS was shown to be a durable treatment for MDD-TR with 84.73 % of TMS responders having at least a 2-year period post TMS treatment without significant relapse as defined by SPEAR. 35.4 % of responders were found to have at least a 2-year period without requirements for changes to their psychopharmacological regimens. No covariates analyzed were associated with differences in TMS durability.

Results indicate that TMS produces a durable response in Veterans with MDD-TR when measured by markers of severe relapse. Prospective studies analyzing different markers of relapse and larger sample sizes are needed.