Repetitive transcranial magnetic stimulation for treatment-resistant depression in Singapore: a retrospective,...

Naturalistic repetitive transcranial magnetic stimulation (rTMS) outcome data for treatment-resistant depression remain limited in Southeast Asia. This retrospective study describes such outcomes from a general hospital in Singapore.

28 outpatients received rTMS (10Hz high-frequency or intermittent theta-burst) targeting the left dorsolateral prefrontal cortex (F3 scalp position) between May 2022 and May 2025. Treatment-resistant depression was defined as failing ≥2 antidepressant classes for ≥6 weeks each. The primary outcome was change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score; secondary outcomes included the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16), the Depression, Anxiety and Stress Scale-21 (DASS-21), the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), the Clinical Global Impression-Severity (CGI-S), and the Global Assessment of Functioning (GAF).

Despite 85.7% of patients having failed ≥3 antidepressant classes, the mean MADRS score decreased by 15.8 (SD 9.1), from 29.6 (SD 7.6) to 13.9 (SD 11.1, p<0.001). This corresponded to a 67.9% response rate and a 57.1% remission rate. All secondary measures (QIDS-SR16, DASS-21, Q-LES-Q-SF, CGI-S, and GAF) showed significant improvements (all p<0.001). Shorter episode duration and higher baseline quality of life were significantly associated with remission.

We report favourable response (67.9%) and remission (57.1%) rates within a general hospital cohort in Singapore following standardised rTMS targeting the left dorsolateral prefrontal cortex (approximated by the F3 position), despite extensive prior antidepressant medication failure. These findings contribute real-world data to the limited Southeast Asian literature on standardised rTMS protocols for treatment-resistant depression in general hospital and similar clinical settings.