Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry
Background: The number of sessions in an acute TMS course for major depressive disorder (MDD) is greater than in the earlier randomized controlled trials. Objective: To compare clinical outcomes in groups that received differing numbers of TMS sessions. Methods: From a registry sample (N = 13,732),...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Brain Stimulation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X23019265 |
| _version_ | 1797644706399649792 |
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| author | Todd M. Hutton Scott T. Aaronson Linda L. Carpenter Kenneth Pages David Krantz Lindsay Lucas Bing Chen Harold A. Sackeim |
| author_facet | Todd M. Hutton Scott T. Aaronson Linda L. Carpenter Kenneth Pages David Krantz Lindsay Lucas Bing Chen Harold A. Sackeim |
| author_sort | Todd M. Hutton |
| collection | DOAJ |
| description | Background: The number of sessions in an acute TMS course for major depressive disorder (MDD) is greater than in the earlier randomized controlled trials. Objective: To compare clinical outcomes in groups that received differing numbers of TMS sessions. Methods: From a registry sample (N = 13,732), data were extracted for 7215 patients treated for MDD with PHQ-9 assessments before and after their TMS course. Groups were defined by number of acute course treatment sessions: 1–19 (N = 658), 20–29 (N = 616), 30–35 (N = 1375), 36 (N = 3591), 37–41 (N = 626), or >41 (N = 349) and compared in clinical outcomes at endpoint and at fixed intervals (after 10, 20, 30, and 36 sessions). The impact of additional treatments beyond 36 sessions was also examined. Results: Groups that received fewer than 30 sessions had inferior endpoint outcomes than all other groups. PHQ-9 symptom reduction was greatest in the group that ended treatment at 36 sessions. The extended treatment groups (>36 sessions) differed from all other groups by manifesting less antidepressant response early in the course and had a slower but steady rate of improvement over time. Extending treatment beyond 36 sessions was associated with further improvement without evidence of a plateau. Conclusions: In real-world practice, there are strong relations between the number of TMS sessions in a course and the magnitude of symptom reduction. Courses with less than 30 sessions are associated with diminished benefit. Patients with longer than standard courses typically show less initial improvement and a more gradual trajectory, but meaningful benefit accrues with treatment beyond 36 sessions. |
| first_indexed | 2024-03-11T14:35:59Z |
| format | Article |
| id | doaj.art-ac81f2248ce44dcaa1523e9b88e247d6 |
| institution | Directory Open Access Journal |
| issn | 1935-861X |
| language | English |
| last_indexed | 2024-03-11T14:35:59Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain Stimulation |
| spelling | doaj.art-ac81f2248ce44dcaa1523e9b88e247d62023-10-31T04:09:10ZengElsevierBrain Stimulation1935-861X2023-09-0116515101521Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registryTodd M. Hutton0Scott T. Aaronson1Linda L. Carpenter2Kenneth Pages3David Krantz4Lindsay Lucas5Bing Chen6Harold A. Sackeim7Southern California TMS Center, Pasadena, CA, USASheppard Pratt Health System, Baltimore, MD, USA; Department of Psychiatry, University of Maryland, Baltimore, MD, USAButler Hospital, Providence, RI, USA; Brown University Department of Psychiatry and Human Behavior, Providence, RI, USATMS of South Tampa, Tampa, FL, USANAMSA, St. Louis Park, MN, USANAMSA, St. Louis Park, MN, USANAMSA, St. Louis Park, MN, USADepartment of Psychiatry, Columbia University, NY, USA; Department of Radiology, Columbia University, NY, USA; Corresponding author. Vagelos College of Physicians and Surgeons of Columbia University, New York, NY, USA.Background: The number of sessions in an acute TMS course for major depressive disorder (MDD) is greater than in the earlier randomized controlled trials. Objective: To compare clinical outcomes in groups that received differing numbers of TMS sessions. Methods: From a registry sample (N = 13,732), data were extracted for 7215 patients treated for MDD with PHQ-9 assessments before and after their TMS course. Groups were defined by number of acute course treatment sessions: 1–19 (N = 658), 20–29 (N = 616), 30–35 (N = 1375), 36 (N = 3591), 37–41 (N = 626), or >41 (N = 349) and compared in clinical outcomes at endpoint and at fixed intervals (after 10, 20, 30, and 36 sessions). The impact of additional treatments beyond 36 sessions was also examined. Results: Groups that received fewer than 30 sessions had inferior endpoint outcomes than all other groups. PHQ-9 symptom reduction was greatest in the group that ended treatment at 36 sessions. The extended treatment groups (>36 sessions) differed from all other groups by manifesting less antidepressant response early in the course and had a slower but steady rate of improvement over time. Extending treatment beyond 36 sessions was associated with further improvement without evidence of a plateau. Conclusions: In real-world practice, there are strong relations between the number of TMS sessions in a course and the magnitude of symptom reduction. Courses with less than 30 sessions are associated with diminished benefit. Patients with longer than standard courses typically show less initial improvement and a more gradual trajectory, but meaningful benefit accrues with treatment beyond 36 sessions.http://www.sciencedirect.com/science/article/pii/S1935861X23019265Transcranial magnetic stimulation (TMS)EfficacyTreatment durationNumber of sessionsRegistry |
| spellingShingle | Todd M. Hutton Scott T. Aaronson Linda L. Carpenter Kenneth Pages David Krantz Lindsay Lucas Bing Chen Harold A. Sackeim Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry Brain Stimulation Transcranial magnetic stimulation (TMS) Efficacy Treatment duration Number of sessions Registry |
| title | Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry |
| title_full | Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry |
| title_fullStr | Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry |
| title_full_unstemmed | Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry |
| title_short | Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry |
| title_sort | dosing transcranial magnetic stimulation in major depressive disorder relations between number of treatment sessions and effectiveness in a large patient registry |
| topic | Transcranial magnetic stimulation (TMS) Efficacy Treatment duration Number of sessions Registry |
| url | http://www.sciencedirect.com/science/article/pii/S1935861X23019265 |
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