Transcranial Magnetic Stimulation Retreatment for Recurrent Depression: A Large Real-World Multisite Cohort Study

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Medicine

Background:

• Recurrent major depressive disorder (MDD) poses challenges when initial treatment response wanes.
• Limited evidence exists for the efficacy of a second acute course of transcranial magnetic stimulation (TMS) after symptom recurrence.
• This study addresses the need for data on retreatment with TMS for patients with MDD.

Purpose of the Study:

• To estimate the frequency and speed of patient benefit from a second acute TMS course in recurrent MDD.
• To compare response and remission rates between initial and second TMS courses.
• To analyze the time to response during retreatment versus initial treatment.

Main Methods:

• Retrospective cohort study across 20 outpatient centers.
• Included 259 patients with recurrent MDD receiving ≥2 TMS courses; 177 prior responders formed the primary cohort.
• Standard 10-Hz left dorsolateral prefrontal cortex TMS was used; response (≥50% PHQ-9/BDI-II reduction) and remission (PHQ-9 ≤4 /BDI-II ≤9) were assessed.

Main Results:

• 82.5% of prior responders (146/177) achieved response during the second TMS course.
• 54.2% of prior responders (96/177) achieved remission.
• Symptom reduction was significant (PHQ-9 median 65.0%, BDI-II mean 12.0 points).
• Time to first response was faster during the second course compared to the initial course for both PHQ-9 and BDI-II.

Conclusions:

• The majority of patients with recurrent MDD who previously responded to TMS show improvement with a second course.
• Retreatment with TMS is effective for symptom recurrence in MDD.
• Response to TMS may occur more rapidly during subsequent treatment courses.