Depressive symptom trajectories with prolonged rTMS treatment

Xiao Chen; Daniel M Blumberger; Jonathan Downar; Victoria J Middleton; Naima Monira; Jennifer Bowman; Joseph Kriske; John Kriske; Nancy Donachie; Tyler S Kaster

doi:10.1016/j.brs.2024.04.010

Depressive symptom trajectories with prolonged rTMS treatment

Brain Stimul. 2024 Apr 18;17(3):525-532. doi: 10.1016/j.brs.2024.04.010. Online ahead of print.

Authors

Affiliations

¹ CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, 100101, China; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China; Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; International Big-Data Center for Depression Research, Chinese Academy of Sciences, Beijing, 100101, China.
² Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, M5T1R8, Ontario, Canada.
³ Salience Health Solutions, Plano, 75024, Texas, USA.
⁴ Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, M5T1R8, Ontario, Canada. Electronic address: tyler.kaster@camh.ca.

PMID: 38641170
DOI: 10.1016/j.brs.2024.04.010

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.