Use of Transcranial Magnetic Stimulation in Treatment Resistant Depression in MU Health Care: Effectiveness and Outcome

Background: Transcranial magnetic stimulation (TMS) received FDA approval in 2008 for Major depressive disorder. This study was completed to determine the efficacy of rTMS (repetitive TMS) in the management of patients with treatment resistant depression attending our Neuromodulation clinic from September 2018 through January 2020. Methods: 91 patients aged ≥ 18 were treated with rTMS for a maximum of 36 sessions. A Magventure Magpro X100 TMS machine was used and the coil was positioned over the left dorsolateral prefrontal cortex and patients were treated at 120% of their Motor threshold, either with a 3 min theta burst or 20 min standard protocol. All patients in the study had failed at least two antidepressants and psychotherapy. Results: Out of 91 patients, 9 could not complete the treatment. 82 patients were thus included in the study. 33 patients (44%) achieved remission. Remission rate was defined as ≤ 4 on the PHQ9 or QIDS. 18 patients (22%) of the patients responded to the treatment (QIDS or PHQ score reduction >50%). Therefore, 62% of the patients benefited from the procedure. 4 patients (5%) reported worsening of symptoms. 5 patients (6%) had no resolution of symptoms. 27% of the subjects had some improvement in symptoms but did not reach response or remission criteria. Conclusion: Our response and remission rates are comparable to previous randomized controlled studies of rTMS for major depression and has shown positive outcome in patients with treatment resistant depression. Conflict of interest: None. Funding: No funding received.