Accelerated repetitive transcranial magnetic stimulation in the treatment of depressive disorder resistant to a course of antidepressant medication

AimsIt is generally known that 30% of Major depressive disorder (MDD) patients do not respond to traditional pharmacological and psychosocial therapy. Transcranial magnetic stimulation (TMS), introduced first in 1985, was a non-invasive neural network research method. Later, repetitive Transcranial Magnetic Stimulation (rTMS) was approved by the FDA to treat treatment-resistant depression (TRD) in 2008. Over the past two decades, rTMS has been extensively developed using various protocols in order to stimulate superficial brain nerve cells non-invasively. We planned to see if high-frequency accelerated left prefrontal rTMS can improve symptoms of treatment resistant depression given its convenience it provides by having patients for fewer treatment sessions.MethodsA total of 25 patients were enrolled in the study. Inclusion criteria were age between 18 and 60 and a history of at least one failed treatment with antidepressants. The treatment was conducted over six days scattered over three weeks and each day consisted of three 30-minute sessions (83, 83, and 84 trains for each session). The sessions were separated with 15-minute breaks. rTMS protocol: 120% of the motor threshold and frequency of 10 Hz. Consisting of 2.4 s trains with an intertrain interval of 15-seconds.ResultThe study included 25 individuals (male: 12/13) with an average age of 36.88 +/- 10.61. We compared outcome indicators at baseline and week three after confirming the normality of the data. After three weeks, Hamilton Depression Rating Scale and Clinician Global Impression showed a substantial improvement. There was a remission rate of 24% (6/25) and a response rate of 52% (13/25).ConclusionThis work adds to the evidence that rTMS can treat TRD and shows that a more convenient high-frequency accelerated rTMS can improve symptoms in treatment resistant depression.