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. 2024 May-Jun;17(3):525-532.
doi: 10.1016/j.brs.2024.04.010. Epub 2024 Apr 18.

Depressive symptom trajectories with prolonged rTMS treatment

Xiao Chen  1 , Daniel M Blumberger  2 , Jonathan Downar  2 , Victoria J Middleton  3 , Naima Monira  3 , Jennifer Bowman  3 , Joseph Kriske  3 , John Kriske  3 , Nancy Donachie  3 , Tyler S Kaster  4
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Free article

Depressive symptom trajectories with prolonged rTMS treatment

Xiao Chen et al. Brain Stimul. 2024 May-Jun.
Free article

Abstract

Background: A prolonged repetitive transcranial magnetic stimulation (rTMS) treatment course could be beneficial for some patients experiencing major depressive episodes (MDE). We identified trajectories of rTMS response in depressive patients who received an extended rTMS treatment course and sought to determine which trajectories achieved the greatest benefit with a prolonged treatment course.

Method: We applied group-based trajectory modeling to a naturalistic dataset of depressive patients receiving a prolonged course of sequential bilateral rTMS (up to 51 treatment sessions) to the dorsolateral prefrontal cortex. Trajectories of the PHQ-9 with extended treatment courses were characterized, and we explored the association between baseline clinical characteristics and group membership using multinomial logistic regression.

Results: Among the 324 study participants, four trajectories were identified: "linear response, extended course" (N = 73; 22.5 %); "nonresponse" (N = 23; 7.1 %); "slowed response" (N = 159; 49.1 %); "rapid response, standard treatment length" (N = 69; 21.3 %). Only the "linear response, extended course" group showed considerable clinical improvement after receiving additional rTMS treatments. Greater baseline depressive symptoms were associated with linear response and non-response.

Conclusion: Our results confirmed the distinctive response trajectories in depressive patients receiving rTMS and further highlighted that prolonged rTMS treatment courses may be beneficial for a subset of patients with higher initial symptom levels and linear early treatment response.

Keywords: Bilateral rTMS; Group-based trajectory modeling; Major depressive disorder; Naturalistic study; Repetitive transcranial magnetic stimulation; Treatment outcome.

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Conflict of interest statement

Declaration of competing interest Xiao Chen has received research support from the National Natural Science Foundation of China, the China Scholarship Council, and the Chinese Academy of Sciences. Daniel M. Blumberger has received research support from CIHR, NIH, Brain Canada, and the Temerty Family through the CAMH Foundation and the Campbell Family Research Institute. He received research and in-kind equipment support for an investigator-initiated study from Brainsway Ltd. He is the site principal investigator for three sponsor-initiated studies for Brainsway Ltd. He also receives in-kind equipment support from Magventure for investigator-initiated research. He received medication supplies for an investigator-initiated trial from Indivior. Jonathan Downar has received research support from NIH, CIHR, Brain Canada, Ontario Brain Institute, the Klarman Family Foundation, the Krembil Foundation, Arrell Family Foundation, and the Buchan Family Foundation, in-kind equipment support for investigator-initiated trials from MagVenture, is an advisor for BrainCheck, Arc Health Partners and Salience Neuro Health, and is a co-founder of Ampa Health. Tyler S. Kaster is supported by the Canadian Institute for Health Research and the AFP Innovation Fund. Study data was provided at no cost by Salience Health. No funding was provided for the analysis, or manuscript creation. Victoria J. Middleton, Naima Monira, Jennifer Bowman, Joseph Kriske, John Kriske, and Nancy Donachie are employees of Salience Health.

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