Clinical efficacy of accelerated vs. standard H1-coil TMS dosing: a prospective, multisite, 12-month durability study

A recent multicenter trial compared five-times-daily accelerated intermittent theta burst stimulation (ACC-iTBS) deep TMS with standard-of-care high-frequency (SOC-HF) deep TMS in adults with MDD. The goal of the current study was to assess the long-term durability of these outcomes over one year.

Response and remission rates based on the clinician-rated HDRS-21 and MADRS were assessed at 3, 6, 9 and 12 months. Mood, anxiety, and quality of life were assessed with the CUDOS, CUXOS, and Q-LES-Q-SF, and rates of medication change and additional TMS were recorded.

Sixty-five of 89 parent-trial completers (73%) consented to the durability study. At 12 months, HDRS-21 response/remission were 94.4%/83.3% for ACC-iTBS and 88.0%/88.0% for SOC-HF. The longitudinal HDRS-21 group-by-time interaction was not significant (F=0.3622, p=0.7804; approximate partial eta-squared=0.011). Across follow-up, PHQ-9 remission ranged from 53%-77% (ACC-iTBS) and 33%-58% (SOC-HF), while CUXOS remission ranged from 68%-85% and 61%-83%, respectively. At 12 months, Q-LES-Q-SF scores were >=73% in 68.4% of ACC-iTBS and 76.9% of SOC-HF participants, while severe impairment (<=60.2%) was present in 0% and 11.5%, respectively. Eighty percent of participants had no medication increase/augmentation, 80% received no additional TMS, and 66% required neither.

Clinical improvement in depression, anxiety, and quality of life persisted for at least one year following both accelerated and standard high-frequency deep TMS with the H1 coil.