Outcomes and feasibility from the first TMS specific web-based intervention

Abstract

Background: The authors sought to review the feasibility of an intervention combined with transcranial magnetic stimulation (TMS) for patients with Major Depressive Disorder (MDD) and assess outcomes on a self-rated measure of mood. Methods: A post hoc analysis was performed with de-identified data from patient users of the workbook. A subset of data was identified, n=20, and analyzed. This subset of patients had verified daily workbook use and a complete data set (diagnosis, demographics, medication history, TMS treatment protocols, number of delivered TMS sessions, weeks of workbook participation, etc.). Results: Overall patient PHQ-9 outcomes for the group were: Remission = 60%, Response = 85%, Nonresponse = 15%. The analysis showed that use of the workbook is feasible by a TMS operator and patients with electronic tablets and smartphones. Demographics of the patients were 50% (10/20) female, and 50% (10/20) male, with an average age of 33 years old, (range: 18-58). All patients had a primary diagnosis of Major Depressive Disorder, recurrent, severe and were quite treatment-resistant with an average number of antidepressants used prior to TMS initiation of 6.2 antidepressants (range of 4-18), and the average number of augmenting agents (antipsychotics, stimulants, anti-anxiety, folate supplements, e.g.) of 7.3 (range 1-20). The patients had an average of 41 (range 26-59) treatments and an average workbook use of 10.25 weeks (range 8-14 weeks of use). Of the patients treated throughout their TMS course with the standard protocol (10/20), PHQ-9 outcomes were: Remission = 80%, Response = 90%, Nonresponse = 10%. Conclusion: This study showed that the HIPAA compliant, web-based workbook can feasibly be used by TMS operators in combination with TMS Treatment for depressed patients. The interpretation of the reported outcome results is limited by the small number, the post hoc nature of the data analysis, and the lack of a randomized comparator group. A randomized clinical trial to test this workbook against nonconcurrent TMS and online CBT or other interventions, with specific education to improve operator and patient utilization, might answer if this combined intervention can improve outcomes for patients compared to standard TMS treatment. Funding: NeuroScience & TMS Treatment Centers Disclosures: - Dr. Cochran is the owner and author of Train Your Brain: Your record of Care with TMS, www.TMSworkbook.com. - Dr. Cochran is on the speaker’s bureau for NeuroStar/Neuronetics and has done market research for MagStim and NeuroStar/Neuronetics. - Dr. Cochran owns a practice, NeuroScience and TMS Treatment Centers which purchased both a MagVenture device and two NeuroStar devices which are used with patients. - Lauren Valencia, LCSW is one of the authors of Train Your Brain, TMSworkbook.com and works with Dr. Cochran - Kayla Evans is a TMS operator in Dr. Cochran’s practice. - C. Dean Cochran is Dr. Cochran’s son and a Data Science Analytics major at Centre College, Danville, KY.