The effects of extended rTMS treatment course on response outcome in patients with Major Depressive Disorder - Salience 51

Abstract

Background: A naturalistic study was conducted to assess the effects of 15 additional rTMS treatments on patients (i.e., Salience 51 patients) diagnosed with Major Depressive Disorder (MDD) who failed to achieve and maintain remission (≥70% improvement from baseline PHQ-9 score) for two consecutive weeks, after an acute course of rTMS (36 treatments) ((ntotal = 90), nmales =3 1, Mage = 43.8 years, SD = 18.84). Treatment effects were measured using the PHQ-9, GAD-7, CHRT, QIDS, and Zung self-rater scales. Methods: Salience 51 patients received 15 additional rTMS treatments after their acute course of 36 treatments. Treatments were administered over the right (1 Hz, 360 pulses) and left (20 Hz, 1200 pulses) dorsolateral prefrontal cortex (dlPFC) at 120% motor threshold, five times a week for approximately eight weeks. Assessments were completed before treatment, at weekly intervals, at treatment 36, and at the end of the treatment. Results: Response rate (≥ 50% improvement on PHQ-9) increased from 45.56% of patients at treatment 36 to 62.22% of patients after 51 treatments. Analysis of variance showed a main effect of additional 15 treatments on treatment response outcome at start, treatment 36, and end PHQ9 [F(2, 267) = 82.02, p < .001, ƞ2p = 0.38]. A Bonferroni post-hoc comparison indicates that the initial mean PHQ-9 score (M = 15.9, SD = 23.08) was significantly different than at treatment 36 (M = 9.03, SD = 20.28). Even greater mean difference of -8.31 was found between initial and ending mean PHQ-9 (M = 7.59, SD = 21.55) scores. Conclusions: The findings support the need for an individualized number of rTMS treatments to reach maximized potential treatment response, as 46% of Salience 51 patients reported a continued decrease of depressive symptoms after treatment 36. Funding: Patients who were already seeking TMS treatment were financially responsible for their acute courses of TMS Therapy. The acute course may have been covered by insurance and/or privately paid for by the patient. If the patients qualified for the study, they were given the option to participate in the study. They received 15 additional TMS treatments provided by our company, a private clinical practice, at no cost to the patient and they were under no obligation to participate or finish the study.