Real-World Outcomes and Predictors of Accelerated rTMS Treatment Response for Treatment-Resistant Depression

IntroductionAccelerated repetitive transcranial magnetic stimulation (rTMS) is a high-dose precision-targeted treatment that can induce rapid remission from depressive symptoms with only five days of treatment. However, real-world outcomes and the various demographic, clinical, and treatment variables that influence its effectiveness are not fully known. ObjectiveTo determine real-world outcomes of accelerated rTMS treatment for treatment-resistant depression and identify predictors of treatment response. MethodsThis retrospective analysis included 226 individuals treated in an outpatient clinic. Demographics, clinical history, and accelerated rTMS treatment parameters were extracted from medical records. Outcomes were evaluated within 1-month of treatment and general linear models examined predictors of treatment response in various subgroups. ResultsAccelerated rTMS demonstrated substantial response rates within the first month (66% with neuronavigation; 63% without neuronavigation). Response rate was independent of the number of antidepressant failures, prior ECT, or prior TMS, illustrating its utility for patients with a high degree of treatment resistance. Significant predictors of positive treatment response included resting-state functional magnetic resonance imaging (fMRI)-guided targets and female gender. DiscussionAccelerated rTMS is effective for treatment-resistant depression in an outpatient clinical setting. fMRI-guided targeting significantly improved outcomes, suggesting that it provides added benefit over conventional targeting. Additionally, female patients showed better responses, in line with previous literature. These findings highlight the value of personalized approaches in clinical practice and warrant further investigation in larger clinical trials.