Abstract
Objective: The aim of this paper is to present the service data results from a clinical repetitive Transcranial Magnetic Stimulation (rTMS) service treating treatment resistant depression (TRD). Methods: The study was a retrospective investigation of routinely collected data on patients receiving rTMS between 2015 and 2018. Measures used were the clinician-rated Clinical Global Impression (CGI) and Hamilton Depression Rating Scale (HAM-D), and patient rated Physical Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7). The outcome data of 144 patients with TRD was analysed. The sample included patients with co-morbid psychiatric diagnosis. Results: Response and remission rates respectively were 34.6% and 20.6% for the HAM-D; 10% and 28.6% for the PHQ-9; 31% and 31.8% for the CGI; and 24.6% and 28.8% for GAD-7. Effect sizes were mostly medium (0.48, 0.27, 0.51, 0.43 respectively). GAD-7 reliable change improvement was 56.1% and PHQ-9 reliable change improvement was 40%. There was a medium positive correlation between anxiety (GAD-7) and depression recovery (HAM-D), r = 0.31, n = 46, p = 0.039, with lower pre-treatment anxiety associated with lower post-treatment HAM-D scores. Conclusions: TRD patients with low pre-treatment anxiety levels respond to treatment better than those with high pre-treatment anxiety. The results show that a clinical rTMS service can have a significant impact on symptoms of depression and anxiety in TRD. The findings support wider availability of rTMS as a treatment option for people with TRD.
Highlights
IntroductionThe leading cause of disability worldwide is major depressive disorder (clinical depression); it is a major contributor to the overall global burden of disease (WHO, 2017)
The leading cause of disability worldwide is major depressive disorder; it is a major contributor to the overall global burden of disease (WHO, 2017)
The aim of this paper is to present the service data results from a clinical repetitive Transcranial Magnetic Stimulation service treating treatment resistant depression (TRD)
Summary
The leading cause of disability worldwide is major depressive disorder (clinical depression); it is a major contributor to the overall global burden of disease (WHO, 2017). The impact and treatment of depression carries a large cost to society through care and treatment costs and the loss of productivity and societal contribution of those affected (Greenberg et al, 2015). Relapse rates remain significant, highlighting the chronicity of depressive disorders for some (Huynh & McIntyre, 2008). A US study reported that over 50% of people did not experience remission after first-line antidepressant treatment, and one-third did not experience remission after four courses of different treatment (Rush et al, 2006). A multi-site study in Europe reported that 50% did not respond to two consecutive courses of antidepressant treatment (Souery et al, 2007). Many people do not respond to recommended treatments that are generally available in first world economies, and some who respond initially may relapse and become unresponsive to subsequent treatment
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