Outcomes of TMS treatments for Montana Medicaid patients

Abstract

Background: Our practice began treating Medicaid patients with TMS in 2020 following Montana Medicaid’s approval for TMS treatment in those with treatment-resistant depression. In Montana, 37% of Medicaid enrollees have a behavioral health diagnosis. We report on the response of these patients to encourage other states’ Medicaid programs also to cover TMS for these patients. Objectives: This study aimed to assess the clinical efficacy of Transcranial Magnetic Stimulation in a Medicaid population subset. All patients recorded PHQ-9, BDI-II, and GAD-7 scores before beginning treatment, at weekly intervals, and the conclusion of treatment. Methods: From 2020 to 2022, we prescribed and treated 12 (n=12) Medicaid patients who had a history of severe treatment-resistant depression with a complete course of 36 TMS therapy treatments. Each patient met the Montana Medicaid TMS criteria of failure of at least four different optimized or intolerable antidepressants from two distinctly different medication classes. Treatments were delivered using the Magventure MagVita device over nine weeks. Patients receive five treatments per week in the first six weeks, then six in the standard taper protocol over three weeks (3,2,1). Overall Results: Patients included eight females and four males with an average age of 31 years old. The average baseline PHQ-9 score was 22.7, BDI-II baseline score of 47.6, and GAD-7 baseline score of 17.4. These scores indicate a patient population with severe depression and severe anxiety. The PHQ-9 showed a response rate of 42% (n=5) and a remission rate of 17% (n=2). BDI-II response rate was 58% (n=7), and the remission rate of 42% (n=5). The GAD-7 response rate was 42% (n=5) and remission was 33% (N=4). 1 of 12 patients withdrew before completing the entire treatment course due to medical issues unrelated to the TMS treatment. The most common side effects were headaches and fatigue. No adverse events were seen. Results of males: Based on the PHQ-9 and the BDI-II, males (n=4) achieved a response rate of 100% and a remission rate of 50% (n=2). Results of females: Based on the BDI-II, females (n=8) achieved a response rate of 50% (n=4) and a remission rate of 25% (n=2). Conclusions: Our study demonstrated that TMS is a highly effective treatment option for the Medicaid population. Although TMS was slightly less effective than results published in non-Medicaid patients, we attribute this to three significant facts. First, the patients had severe symptoms reported on the PHQ-9 and BDI-II scores. Second, our female patients had prevalent trauma histories and a high incidence of comorbid personality disorders. Lastly, our rural state posed a significant challenge. For example, two male patients came from rural areas and rented housing to receive nine weeks of treatments. We are optimistic about offering TMS treatments for Medicaid patients as over half the participants achieved response criteria (n=7), and 42% (n=5) achieved remission criteria based on the BDI-II. We encourage other state Medicaid programs to offer this to their Medicaid patients. Conflicts: of Interest: None. Funding: No external funding