rTMS for treatment resistant depression - a single center community experience

Depression remains a major health issue worldwide. Chronic treatment resistant depression, where there is a failure to respond to two or more antidepressant regimens, affects 2.5 percent of the adult population. Repetitive transcranial magnetic stimulation (rTMS) is an accepted treatment modality for depression. The comprehension of its mechanism of action and optimal parameters for treatment are evolving. We performed a chart review of the patient population with treatment resistant depression treated at our center with rTMS over the past ten years, using a sequential bilateral hemisphere stimulation approach. Patients were evaluated using the Beck Depression Inventory questionnaire (BDI-II) before onset and every 2 weeks during their rTMS treatments. We also attempted to contact the patients who had completed treatment to repeat the BDI-II and assess long term impacts of treatment. Fifty-three patient charts were analyzed. The overall incidence of responders and those who achieved remission was 58.5% (n=31) and 20.8% (n=11) respectively. Nine patients were contacted following completion of treatment and completed the BDI-II evaluations. The average time between the completion of their rTMS treatment and follow-up was 2.6 years (SD = 2.7 years). Eight of the nine had achieved a significant improvement during their rTMS treatment and 6 maintained their benefit. Overall, our results suggest that using a sequential bilateral hemisphere rTMS stimulation approach delivered in a real-world community for unselected patients with chronic, severe, treatment resistant depression is effective with efficacy results comparable to those achieved in clinical trials of major depression and that in some cases, the clinical benefit can persist over the long term.