Accelerated repetitive transcranial magnetic stimulation in the treatment of depressive disorder resistant to a course of antidepressant medication

Abstract Aims It is generally known that 30% of Major depressive disorder (MDD) patients do not respond to traditional pharmacological and psychosocial therapy. Transcranial magnetic stimulation (TMS), introduced first in 1985, was a non-invasive neural network research method. Later, repetitive Tra...

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Main Authors: Mahtab Motamed, Azin Fathi, Arman Hajikarim-Hamedani, Javad Alaghband-rad
Format: Article
Language:English
Published: BMC 2025-05-01
Series:Annals of General Psychiatry
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Online Access:https://doi.org/10.1186/s12991-025-00572-y
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Summary:Abstract Aims It is generally known that 30% of Major depressive disorder (MDD) patients do not respond to traditional pharmacological and psychosocial therapy. Transcranial magnetic stimulation (TMS), introduced first in 1985, was a non-invasive neural network research method. Later, repetitive Transcranial Magnetic Stimulation (rTMS) was approved by the FDA to treat treatment-resistant depression (TRD) in 2008. Over the past two decades, rTMS has been extensively developed using various protocols in order to stimulate superficial brain nerve cells non-invasively. We planned to see if high-frequency accelerated left prefrontal rTMS can improve symptoms of treatment resistant depression given its convenience it provides by having patients for fewer treatment sessions. Methods A total of 25 patients were enrolled in the study. Inclusion criteria were age between 18 and 60 and a history of at least one failed treatment with antidepressants. The treatment was conducted over six days scattered over three weeks and each day consisted of three 30-minute sessions (83, 83, and 84 trains for each session). The sessions were separated with 15-minute breaks. rTMS protocol: 120% of the motor threshold and frequency of 10 Hz. Consisting of 2.4 s trains with an intertrain interval of 15-seconds. Result The study included 25 individuals (male: 12/13) with an average age of 36.88 ± 10.61. We compared outcome indicators at baseline and week three after confirming the normality of the data. After three weeks, Hamilton Depression Rating Scale and Clinician Global Impression showed a substantial improvement. There was a remission rate of 24% (6/25) and a response rate of 52% (13/25). Conclusion This work adds to the evidence that rTMS can treat TRD and shows that a more convenient high-frequency accelerated rTMS can improve symptoms in treatment resistant depression. Graphical Abstract
ISSN:1744-859X