Long-term efficacy of repeated daily prefrontal transcranial magnetic stimulation (tms) in treatmnt-resistant depression
Depression and Anxiety, 06/13/2012
Mantovani A et al. – While one third of the sample was lost to follow–up, the results demonstrate that most patients contributing to observations experienced persistence of benefit from transcranial magnetic stimulation (TMS) followed by pharmacotherapy or no medication. Longer follow–up and more rigorous studies are needed to explore the true long–term durability of remission produced by TMS.Methods
- Patients were remitters from an acute double-blind sham-controlled trial of TMS (n = 18), or from an open-label extension in patients who did not respond to the acute trial (n = 43).
- Long-term durability of TMS acute effect was examined in remitters over a 12-week follow-up.
- Relapse, defined as 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20, was the primary outcome.
- Of 61 remitters in the acute trial, five entered naturalistic follow-up and 50 entered the TMS taper.
- Thirty-two patients completed TMS taper and 1-, 2-, and 3-month follow-up.
- At 3-month visit, 29 of 50 (58%) were classified as in remission (HDRS-24 ≤10), two of 50 (4%) as partial responders (30% ≤HDRS-24 reduction <50% from baseline), and one of 50 (2%) met criteria for relapse.
- During the entire 3-month follow-up, five of the 37 patients relapsed (relapse rate = 13.5%), but four of them regained remission by the end of the study.
- The average time to relapse in these five patients was 7.2 ± 3.3 weeks.
- Patients who relapsed had higher depression scores at 1 month.