Findings published in the Journal of Affective Disorders indicated that rTMS effectively treated medication-resistant major depression. The researchers examined prospective data from 435 adult patients with major depressive disorder (MDD) who received rTMS at five university hospitals in France from 2015 to 2020. This is the largest study to evaluate the efficacy of rTMS on the dorsolateral prefrontal cortex (DLPFC) in patients with treatment-resistant depression (TRD) in real-world practice, employing a standardized clinical hetero-assessment.

The patients completed either the Montgomery and Asberg Depression Rating Scale (MADRS) or the Hamilton Depression Rating Scale (HDRS) to assess the severity of depression symptoms before and after treatment with rTMS. Since more participants completed the MADRS, the researchers converted HDRS scores to MADRS, and treatment response was defined as a reduction of at least 50% in MADRS scores.

The researchers performed univariate analyses to study which factors were significantly correlated with the effectiveness of rTMS and then included age, gender, and significant factors in a multivariate model.

Data were analyzed from 435 patients, of whom 66 % were female with treatment-resistant depression and 26% of whom had bipolar depression. The results revealed that the mean improvement was 33% (standard deviation [SD] = 31%), the mean decrease in depression severity assessed by MADRS was 9.47 (8.73), and response and remission rates were 31% and 23%, respectively.

The findings from the multivariate analyses revealed a significant effect of baseline MADRS score on depression score reduction and a correlation with remission with a low baseline MADRS score. Additionally, there were no reports of serious adverse events or potentially predictive events such as seizures or manic switching.

The authors indicated that rTMS appears to be effective in routine clinical practice; however, its efficacy could be enhanced by examining predictors of response, as well as personalized targeting of specific brain areas.

The authors concluded, “Our study adds to real-world evidence of rTMS efficacy, which leads to questions as to why it is used as a second or third-line depression treatment, despite its safety, its increasing availability, and its cost-effectiveness.”

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