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. 2021 Feb 28;19(1):73-83.
doi: 10.9758/cpn.2021.19.1.73.

Rapid Symptom Improvement in Major Depressive Disorder Using Accelerated Repetitive Transcranial Magnetic Stimulation

Soo-Jeong Kim  1   2 , Sang Joon Son  3 , Mi Jang  4 , Byung-Hoon Kim  1   2 , Seok Joo Hong  3 , Lina Seo  3 , Sun-Woo Choi  2 , Jeong-Ho Seok  1   2 , Jai Sung Noh  3
Affiliations

Rapid Symptom Improvement in Major Depressive Disorder Using Accelerated Repetitive Transcranial Magnetic Stimulation

Soo-Jeong Kim et al. Clin Psychopharmacol Neurosci. .

Abstract

Objective: Repetitive transcranial magnetic stimulation (rTMS) has contributed to increase in the remission rate for patients with major depressive disorder (MDD). However, current rTMS treatment is practically inconvenient because it requires daily treatment sessions for several weeks. Accelerated rTMS treatment is as efficient and safe for MDD patients as conventional rTMS.

Methods: Fifty-one patients with MDD participated in this study; they were randomized into accelerated rTMS (n = 21), conventional rTMS (n = 22), and sham-treatment (n = 8) groups. The accelerated and conventional rTMS groups received 15 sessions for 3 days and 3 weeks, respectively. The sham-treatment group received 15 sham rTMS sessions for 3 days. Primary outcome was assessed using self-report and clinician-rated Korean Quick Inventory of Depressive Symptomatology (KQIDS-SR and KQIDS-C, respectively). Adverse effects were monitored using the Frequency, Intensity, and Burden of Side Effects Rating scale. Changes in depressive symptoms were compared among the three groups using mixed model analyses.

Results: For the KQIDS-SR score, there was a significant main effect of "time" (F3,47 = 11.05, p < 0.001), but no effect of "group" (F2,47 = 2.04, p = 0.142), and a trend-level interaction effect of "group × time" (F6,47 = 2.26, p = 0.053). Improvement in depressive symptoms, based on the KQIDS-SR score 3 weeks after treatment, was more prominent in the accelerated rTMS group than in the sham-treatment group (p = 0.011). Tolerability was comparable among the three groups.

Conclusion: The accelerated rTMS treatment group showed rapid improvement of depressive symptoms compared with the sham-treatment and conventional rTMS treatment groups. Therefore, accelerated rTMS treatment could be a viable option for MDD, with improved accessibility.

Keywords: Accessibility; Effectiveness; Major depressive disorder; Safety; Transcranial magnetic stimulation; health services; repetitive; treatment.

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Conflict of interest statement

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
CONSORT flowchart. rTMS, repetitive transcranial magnetic stimulation.
Fig. 2
Fig. 2
The results of self-reported Korean Quick Inventory of De-pressive Symptomatology (KQIDS-SR) across the study time points, analyzed using the linear mixed model 1: Three weeks after treat-ment, the KQIDS-SR score of the accelerated repetitive transcranial magnetic stimulation (rTMS) group was lower than that of the sham- treatment group. 2: Six weeks after treatment, the KQIDS-SR score of the accelerated rTMS group was lower than that of the sham-treat-ment group. 3: Six weeks after treatment, the KQIDS-SR score of the conventional rTMS group was lower than that of the sham-treatment group. *pvalue < 0.05.
Fig. 3
Fig. 3
Comparison of clinical global impression scale-severity (CGI-S) results using linear mixed model analysis 1: Three weeks after treatment, the CGI-S score of the accelerated repetitive transcranial magnetic stimulation (rTMS) group was lower than that of the conventional rTMS group. 2: Six weeks after treatment, the CGI-S score of the accelerated rTMS group was lower than that of the sham-treatment group.
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