Can Maintenance TMS Prevent Relapse in Patients With Treatment-Resistant Depression?

While the majority of clinical research efforts to date have focused on understanding the role of transcranial magnetic stimulation (TMS) as an acute treatment for depression, a growing body of evidence suggests that TMS used as a maintenance therapy is an effective strategy for preventing relapse in patients with treatment-resistant depression, according to Joan A. Camprodon, M.D., Ph.D., M.P.H. (pictured left), an assistant professor of psychiatry at Harvard Medical School, who wrote a column on this topic in a recent issue of Psychiatric News PsychoPharm.

A longitudinal study of 257 adults with treatment-resistant depression found that 70.5% of patients who remit after a full course of TMS remain in remission a year later, and 62.5% of patients who respond retain the therapeutic benefit over the same period. However, 36.2% of the patients followed in this study required more TMS treatments during the one-year follow-up period, ranging from a couple booster sessions to an additional full course (the mean number of sessions was 16.2).

“Interestingly, additional TMS was more likely in the subgroups that obtained initial benefit (42.1% of remitters and 61.4% responders versus 32.2% of partial responders and 19.5% of nonresponders),” Camprodon wrote. “These data tell us two things: the effects of TMS are durable, and additional TMS after the acute course of treatment may have a role in keeping patients well.”

Determining the most effective maintenance protocol for TMS as well as the patients who are the most appropriate to receive it will require appropriately powered clinical trials specifically designed to answer questions related to maintenance, Camprodon noted. “In the meantime, clinicians (and health insurance companies) need to make decisions about the most effective (and cost-effective) treatment choices for patients who are presenting for treatment today.”

For related news, see the Psychiatric News article “Neuromodulation May Benefit Patients With Varying Psychiatric Illnesses,” by Andrew Leuchter, M.D.

(Photo Courtesy of Joan A. Camprodon)