Evaluation of rTMS for treatment-resistant PTSD and depression in active/retired Canadian Armed Forces and RCMP...

Repetitive transcranial magnetic stimulation (rTMS) is an effective, non-invasive treatment option for treatment-resistant posttraumatic stress disorder (TR PTSD) and treatment-resistant depression (TRD). This study assesses left-sided high-frequency (LSHF) rTMS on symptoms of Canadian Armed Forces (CAF) and Royal Canadian Mounted Police (RCMP) members with TRD and TR PTSD at the Carewest Operational Stress Injury clinic.

This feasibility study used a quantitative longitudinal design. The study population included 28 CAF and RCMP members with TR PTSD and TRD, defined as lack of response to two antidepressants and one evidence-based psychotherapy. Patients concurrently undertook biological and psychological treatment as usual. Up to 30 sessions of LSHF rTMS were provided; non-responders switched to right-sided low-frequency (RSLF) rTMS after 20 sessions. Depression and PTSD symptoms were quantified using the PTSD Checklist for DSM-5 (PCL-5) and Patient Health Questionnaire-9 (PHQ-9) before treatment, every 10th session, and at completion. Outcomes were analyzed with one-way repeated-measures analysis of variance.

PHQ-9 scores decreased (p < 0.001) during rTMS treatment, from moderately severe depression at baseline (mean = 18) to moderate depression at the 20th (mean = 11) and 30th (mean = 10) sessions. Similarly, PCL-5 scores significantly decreased (p < 0.001), reaching sub-clinical threshold (initial mean = 48, 20th session mean = 33, and 30th session, mean = 31).

These findings support the efficacy of rTMS for reducing symptoms of TRD and TR PTSD in this population. Larger studies with sham rTMS comparison, blinding, and randomization are needed.