Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry.
Brain Stimul
; 16(5): 1510-1521, 2023.
Article
in En
| MEDLINE
| ID: mdl-37827360
ABSTRACT
BACKGROUND:
The number of sessions in an acute TMS course for major depressive disorder (MDD) is greater than in the earlier randomized controlled trials.OBJECTIVE:
To compare clinical outcomes in groups that received differing numbers of TMS sessions.METHODS:
From a registry sample (N = 13,732), data were extracted for 7215 patients treated for MDD with PHQ-9 assessments before and after their TMS course. Groups were defined by number of acute course treatment sessions 1-19 (N = 658), 20-29 (N = 616), 30-35 (N = 1375), 36 (N = 3591), 37-41 (N = 626), or >41 (N = 349) and compared in clinical outcomes at endpoint and at fixed intervals (after 10, 20, 30, and 36 sessions). The impact of additional treatments beyond 36 sessions was also examined.RESULTS:
Groups that received fewer than 30 sessions had inferior endpoint outcomes than all other groups. PHQ-9 symptom reduction was greatest in the group that ended treatment at 36 sessions. The extended treatment groups (>36 sessions) differed from all other groups by manifesting less antidepressant response early in the course and had a slower but steady rate of improvement over time. Extending treatment beyond 36 sessions was associated with further improvement without evidence of a plateau.CONCLUSIONS:
In real-world practice, there are strong relations between the number of TMS sessions in a course and the magnitude of symptom reduction. Courses with less than 30 sessions are associated with diminished benefit. Patients with longer than standard courses typically show less initial improvement and a more gradual trajectory, but meaningful benefit accrues with treatment beyond 36 sessions.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Depressive Disorder, Major
Limits:
Humans
Language:
En
Journal:
Brain Stimul
Journal subject:
CEREBRO
Year:
2023
Document type:
Article
Affiliation country:
United States