Real-World Outcomes and Predictors of Accelerated rTMS Treatment Response for Treatment-Resistant Depression

Introduction Accelerated repetitive transcranial magnetic stimulation (rTMS) is a high-dose precision-targeted treatment that can induce rapid remission from depressive symptoms with only five days of treatment. However, real-world outcomes and the various demographic, clinical, and treatment variables that influence its effectiveness are not fully known. Objective To determine real-world outcomes of accelerated rTMS treatment for treatment-resistant depression and identify predictors of treatment response. Methods This retrospective analysis included 226 individuals treated in an outpatient clinic. Demographics, clinical history, and accelerated rTMS treatment parameters were extracted from medical records. Outcomes were evaluated within 1-month of treatment and general linear models examined predictors of treatment response in various subgroups. Results Accelerated rTMS demonstrated substantial response rates within the first month (66% with neuronavigation; 63% without neuronavigation). Response rate was independent of the number of antidepressant failures, prior ECT, or prior TMS, illustrating its utility for patients with a high degree of treatment resistance. Significant predictors of positive treatment response included resting-state functional magnetic resonance imaging (fMRI)-guided targets and female gender. Discussion Accelerated rTMS is effective for treatment-resistant depression in an outpatient clinical setting. fMRI-guided targeting significantly improved outcomes, suggesting that it provides added benefit over conventional targeting. Additionally, female patients showed better responses, in line with previous literature. These findings highlight the value of personalized approaches in clinical practice and warrant further investigation in larger clinical trials. ### Competing Interest Statement DDD, EN, VH, KH, DL, OM, NM, ND, and DC are employees with either stock or stock options at Acacia Clinics where the data was collected. SHS is a clinical consultant for Acacia Clinics. SHS is also a scientific consultant for Magnus Medical and a clinical consultant for Kaizen Brain Center and Boston Precision Neurotherapeutics. He has received investigator-initiated research funding independently from Neuronetics and BrainsWay. He has served as a speaker for BrainsWay (branded) and [PsychU.org][1] (unbranded, sponsored by Otsuka). He owns stock in BrainsWay (publicly traded) and Magnus Medical (not publicly traded). ### Funding Statement This study was not funded ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Pearl IRB of Acacia Clinics waived ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data produced in the present study may be available upon reasonable request to the authors. [1]: http://PsychU.org