Depressive symptom trajectories during a 30-session course of repetitive transcranial magnetic stimulation in routine clinical practice: A single-center naturalistic study

Abstract

Objective

To examine longitudinal changes in depressive symptoms during a 30-session course of repetitive transcranial magnetic stimulation (rTMS) in routine clinical practice, with particular attention to symptom change by mid-treatment.

Methods

In this single-center, naturalistic, retrospective observational study, 24 patients with unipolar depressive disorder diagnosed in routine clinical practice according to the International Classification of Diseases, 10th or 11th revision, were included. The primary outcome was change in 17-item Hamilton Depression Rating Scale (HAMD-17) total score at baseline, after 15 sessions, and after 30 sessions, analyzed using a linear mixed-effects model. Secondary analyses examined the 6-item Hamilton Depression Rating Scale (HAMD-6) and the insomnia 3-item score.

Results

HAMD-17 total scores decreased significantly over time. Estimated reductions from baseline were 8.58 points at mid-treatment and 12.99 points at end-of-treatment, corresponding to reductions of 37.9% and 57.4%, respectively. A further 4.41-point reduction was observed from mid-treatment to end-of-treatment. HAMD-6 also decreased significantly across treatment, whereas the insomnia 3-item score improved mainly between baseline and mid-treatment.

Conclusions

In this small real-world cohort, depressive symptom scores decreased during rTMS, with substantial reduction already evident by 15 sessions. Mid-treatment assessment may provide clinically useful information during treatment, although these findings should be interpreted as hypothesis-generating.