Transcranial Magnetic Stimulation (TMS) For Major Depression: A Naturalistic Study

In one of the first studies to look at transcranial magnetic stimulation (TMS) in real-world clinical practice settings, researchers confirmed that TMS is an effective treatment for patients with depression who are unable to find symptom relief through antidepressant medications.

More than 30 published clinical trials have demonstrated that TMS has been effective for treating depression when medications are not sufficient. This study summarized the outcomes of 307 patients from 42 clinical sites who were diagnosed with MDD with persistent symptoms despite the use of antidepressant medication. Change was assessed using both clinicians’ ratings of overall depression severity and scores on patient self-report depression scales, which require the patient to rate the severity of each symptom on the same standardized scale at the end of each 2-week period. Rates for “response” and “remission” to TMS were calculated based on the same cut-off scores and conventions used for other clinical trials of antidepressant treatments. Fifty-eight percent positive response rate to TMS and 37 percent remission rate were observed.

Naturalistic studies differ from controlled clinical trials because they permit the inclusion of subjects with a wider range of symptomatology and comorbidity, whereas clinical trials typically have more rigid criteria for inclusion. This multisite study collected naturalistic outcomes from patients in clinics in various regions in the U.S. which allowed researchers to capture effects that might arise from introducing a novel psychiatric treatment modality like TMS in non-research settings. According to lead author, Linda Carpenter, MD, chief of the Mood Disorders Program and the Neuromodulation Clinic at Butler Hospital, Providence, RI, “the study confirms how well TMS works in diverse settings where TMS is administered to a real-life population of patients with depression that have not found relief through many other available treatments.”

Depression and Anxiety
Volume 29, Issue 7, pages 587–596, July 2012