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Tms durability (9b)

Summary and Comment | TMS in Psychiatry
Fall, 2013

Patients with MDD treated with rTMS still improved after 6 months
Geoffrey Grammer MD reviewing Janicak PG, Nahas Z, Lisanby SH, Solvason HB Brain Stimul. 2010 Oct

In patients pharmacotherapy-resistant MDD who received rTMS, after 6 months, 10% of
patients relapsed, and if they did experience clinical worsening, the vast majority
responded to additional TMS treatments.

Device, Parameters
Background of article
Three hundred one patients were randomly assigned to active or sham rTMS in a 6-week,
controlled trial. Nonresponders could enroll in a second, 6-week, open-label study. Patients who
met criteria for partial response (decreased their baseline HAMD 17 scores by at least 25%)
during either the sham-controlled or open-label study (n = 142) were tapered off rTMS over 3
weeks, while simultaneously starting maintenance antidepressant monotherapy most commonly
with either duloxetine, venlafaxine, buproprion, or escitalopram. Patients were then followed for
24 weeks in order to study the long-term durability of rTMS. Repetitive TMS was re-administered
if patients' symptoms worsened, as determined by any drop on the CGI-S scale for 2 consecutive
weeks. Retreatment consisted of 2 sessions/week for 2 weeks, then 5 sessions/week for 4 weeks
or until symptoms returned to baseline. Relapse was the primary outcome measure. Ten of 99
subjects relapsed during the 24 week observation, defined as meeting DSM-IV criteria for
depression. Thirty-eight of the 99 subjects experienced some symptom worsening and received
additional TMS treatment, which yielded symptomatic benefit in 32 of the 38 (84%).
This is a remarkably complex study that helps answer the vital question of
durability. With 60% of patients maintaining their gains from TMS on
antidepressant monotherapy, providers can reassure patients that benefits for
many are not short lived. Also reassuring is that of those who did have clinical
worsening, the vast majority responded to additional TMS treatments.
Brain Stimul. 2010 Oct;3(4):187-99. doi: 10.1016/j.brs.2010.07.003. Epub 2010 Aug 11.
Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant
major depression: assessment of relapse during a 6-month, multisite, open-label study.

Janicak PG, Nahas Z, Lisanby SH, Solvason HB, Sampson SM, McDonald WM, Marangel LB, Rosenquist P, McCal WV, Kimball J, O'Reardon JP, Loo C, Husain MH, Krystal A, Gilmer W, Dowd SM, Demitrack MA, Schatzberg AF. Department of Psychiatry, Rush University Medical Center, Chicago, Il inois 60612, USA. PubMed Abstract (

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