Response to first course of TMS treatment for depression predicts subsequent response

Abstract

Objective: In patients with treatment-resistant major depression, we evaluated the relationship between treatment response to an initial course of repetitive transcranial magnetic stimulation (rTMS) relative to a subsequent course. Background(s): The benefit of a successful course of rTMS for treatment-resistant depression usually lasts several months, but when symptoms recur it is not known whether a favorable therapeutic response to the initial rTMS course is predictive of the response to a subsequent course. Design/Methods:We performed a retrospective chart review of 225 patients who received rTMS for treatment-resistant depression to identify patients who underwent at least two courses of rTMS, an induction and a reinduction in the setting of symptom relapse. Pearson correlations were calculated to evaluate variables potentially associated with reinduction response, including: response to induction, age, number of reinduction treatment sessions, days between inductions, and severity of depression. Result(s): Sixteen patients were identified (age: 54 +/- 2.2; prior medication trials: 5.3 +/- 0.64; average initial BDI: 29.8 +/- 3.0). There were 10/16 patients who had a favorable response to induction and 11/16 had favorable response to reinduction, with similar responses between the induction and reinduction (% reduction in BDI: 57.9 +/- 7.7 and 56.5 +/- 9.4). Notably, response to the initial rTMS course was the only significant predictor of response to reinduction (r = 0.54, P < 0.04); no other variables approached significance. Conclusion(s): Patients who benefit from rTMS on their initial treatment course appear likely to achieve similar benefits with another course of rTMS if symptoms recur. Disclosures: AP-L serves on the scientific advisory boards for Nexstim, Neuronix, Starlab Neuroscience, Neuroelectrics, Neosync, and Novavision, and is listed as inventor in issued patents and patent applications on the real-time integration of transcranial magnetic stimulation (TMS) with electroencephalography (EEG) and magnetic resonance imaging (MRI).