MAJOR FINDING:

This specific study investigated the efficacy of Transcranial Magnetic Stimulation (TMS) on veterans with Treatment-Resistant Depression (TRD) with comorbid suicide risk and PTSD symptoms. The results were promising; there were clinically significant reductions in symptoms of depression, PTSD, and suicidal ideation at the six-month follow-up relative to pretreatment.

LET’S TAKE A CLOSER LOOK:

TMS has been proven to be an effective treatment for individuals with TRD as it significantly minimizes depressive symptoms and episodes. But do these results hold true for patients with comorbidities such as PTSD and suicide risk? If someone finishes their TMS sessions, do they have to worry about their depressive symptoms returning?

THE PROBLEM: 

Depression is a leading cause of disability worldwide, with U.S. military veterans reporting higher prevalence rates than the general population. Commonly, Veterans also experience elevated rates of medical and psychiatric comorbidities, namely PTSD and suicide risk. While pharmacotherapy and psychotherapy benefit many, a subset of veterans still experience treatment-resistant symptoms. This highlights the need for alternative treatments, such as Transcranial Magnetic Stimulation (TMS), to effectively address depression, PTSD, and associated risk behaviors.

STUDY DETAILS:

Eligibility required failure of more than one antidepressant for current MDD, and possibly comorbid with PTSD or anxiety. Treatment involved 30 sessions, including a tapering phase. Sessions included 55 trains of 36 pulses delivered over 20 minutes at 18 Hz and 120% intensity relative to the Veteran's resting motor threshold. Assessments were conducted at pretreatment, post-treatment, 3-month follow-up, and 6-month follow-up.

RESULTS:

The results showed a significant reduction in depressive symptoms immediately after treatment and maintained at 3 and 6 months post-treatment. Although there was a slight increase in symptoms between the posttreatment and follow-up periods, the overall symptoms remained lower than at the start. Nearly 58% of participants showed a significant reduction in depressive symptoms immediately after treatment, and about 45% maintained this reduction at the six-month mark. Similarly, PTSD symptoms were significantly reduced posttreatment and remained lower than pretreatment levels at follow-up points. Around 75% of participants showed a reduction in PTSD symptoms immediately after treatment, with 57% maintaining these improvements at six months. Suicidal ideation also saw a significant reduction (54.02%).

THE CONCLUSION:

This study demonstrates that deep transcranial magnetic stimulation (dTMS) is a safe and effective treatment for reducing symptoms of depression, PTSD, and suicidal ideation in Veterans with treatment-resistant depression, with significant improvements sustained up to six months post-treatment. The findings highlight the durability of dTMS benefits, suggesting it should be considered a viable long-term treatment option for these conditions.

CITATION:

Hickson, R., Simonsen, M. W., Miller, K. J., & Madore, M. R. (2024). Durability of deep transcranial magnetic stimulation for veterans with treatment resistant depression with comorbid suicide risk and PTSD symptoms. Psychiatry Research, 332, 115690. https://doi.org/10.1016/j.psychres.2023.115690