Page 100 - IDF Journal 2023

IDF News – Spring 2023
Effectiveness of rTMS
Audit Results from the Smart TMS Database 2016 to 2022
Dr Leigh Anthony Neal
Since April 2016, Smart TMS has treated over 800 patients using Transcranial Magnetic Stimulation (TMS). Before, during and after treatment, patients are assessed using well-established self-report psychometric tests. These results are then recorded and analysed annually. rTMS is repetitive Transcranial Magnetic Stimulation. Here, we discuss the results of these patient data audits and what it means for the future of rTMS.
Adverse Effects with TMS
Our recent research investigated the side effects of rTMS in a review of 115 patients, all with a primary diagnosis of depression or obsessive compulsive disorder (OCD). The study found that the most common side effects of rTMS were headaches (20%), fatigue (17%), and scalp discomfort (6%). Importantly, on both high and low frequency treatment, no serious, adverse effects were found in any patient1. These findings are supported by recent research, which found similar prevalence of side effects, and concluded that the risk of seizure was ‘very low’ (standardised risk of 7/100,000 sessions)2. Both studies support the notion that rTMS is a safe way of treating treatment resistant depression.
Major Depressive Disorder
Across our clinics, a total of 251 patients’ data were collected, with an average baseline Patient Health Questionnaire-9 (PHQ-9) score of 19/27. The results demonstrated a remission rate (PHQ- 9<10) of 52%. Furthermore, 30% of patients saw significant improvement in their depressive symptoms, scoring less than 5/27 on the PHQ-9. Overall, 68% of patients saw at least a 20% reduction in their depressive symptoms - indicating that 7 out of 10 people with treatment resistant depression will benefit from rTMS treatment.
Bipolar Depression:
For our audit of bipolar patients treated
at Smart TMS, our sample size was somewhat smaller (19). With an average baseline PHQ-9 score of 19/27, we found that 42% of patients went into remission, and a further 73% of patients saw some clinical benefit from treatment (PHQ-9 reduction of 20% or more). Interestingly, our remission rates were slightly higher (42%) than a recent study (30%) investigating rTMS and bipolar disorder4.
Depression & Co-morbid BPD:
A 2021 study examined depression
and co-morbid borderline personality disorder (BPD), finding that a BPD diagnosis hampers achievements of symptom remission in major depressive disorder (MDD) patients after using antidepressants, psychotherapeutic treatments, or both combined 5. We completed a retrospective chart review of 94 patients, concluding that the severity of co-morbid BPD traits in people with MDD did not predict the outcome of treatment of depression with rTMS. Our audit shares consistent findings with the literature, with a recent study also finding that BPD traits did not affect treatment response to rTMS for MDD6. These findings suggest that rTMS should be the preferred treatment option for patients with BPD and co-morbid depression.
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