Effectiveness and acceptability of accelerated repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depressive disorder: An open label trial

Background: Major depressive disorder (MDD) is a significant cause of worldwide disability and treatment resistance is common. High frequency repetitive transcranial magnetic stimulation (I-IF-rTMS) has emerged as a treatment for MDD, and while efficacious, the daily commitment for typical 4-6 weeks of treatment poses a significant challenge. We aimed to determine the effectiveness and acceptability of an accelerated rTMS protocol for MDD. Methods: In this naturalistic trial, 27 patients with moderate to severe chronic and treatment resistant MDD were treated with twice daily HF-rTIVIS (10 Hz) applied over the left dorsolateral prefrontal cortex for 2 consecutive weeks (60,000 pulses). The primary outcomes were rates of clinical remission and response (16 item Quick Inventory of Depressive Symptomatology post treatment score <6. and > 50% reduction, respectively). Secondary outcomes vvere self reported anxious symptoms, depressive symptoms and quality of life, and dropout rates as a proxy for acceptability. Results: Ten (37.0%) patients met criteria for clinical remission and 15 (55.6%) were classified as responders, with comparable outcomes for both rnoclerate and severe MDD. Clinician rated improvements in depressive symptoms were paralleled in self-reported depressive and anxious symptoms, as well as quality of life. No patient discontinued treatment. Limitations: This study is limited by short treatment duration that might be lengthened with Corresponding improvements in effectiveness, limited duration of follow-up, small sample size, and an open-label design requiring randomized controlled replication. Conclusion: An accelerated protocol involving twice-daily sessions of HF-rTMS over the left DLPFC for 2 weeks was effective in treatment-resistant MDD, and had excellent acceptability. Additional research is required to optimize accelerated rTMS treatment protocols and determine efficacy using sham-controlled trials. (C) 2014 Elsevier B.V. All rights reserved.