Changes in Depressive Symptom Domains During Treatment with Accelerated and Conventional Repetitive Transcranial Magnetic Stimulation

Accelerated 5x5 repetitive Transcranial Magnetic Stimulation (rTMS; five stimulation sessions per day for five days) is an effective treatment for Major Depressive Disorder (MDD), and has efficacy comparable to conventional once-daily rTMS. Considering the heterogeneity of symptoms in patients with MDD, it is critical to determine how accelerated 5x5 and conventional rTMS affect depression symptom domains. We compared symptom change over time in patients treated with either accelerated 5x5 rTMS (25 total sessions, n = 40) or conventional once-daily rTMS administered over six weeks (30 total sessions, n = 135). Accelerated 5x5 patients received either prolonged intermittent theta burst stimulation (piTBS) or personalized "resonant frequency" (RF) stimulation. Mixed-effects linear models were built to compare the two protocols, with the primary outcome variables being the Inventory of Depression Symptomology Self-Report (IDS), the Ruminative Response Scale (RRS), and the Profile of Mood States - Brief (POMS), yielding measures of 14 unique depression symptom domains. Both protocols led to similar improvements in all 14 depression symptom domains (all interaction term p-values > .05). Subsequent exploratory analyses demonstrated that accelerated 5x5 and conventional rTMS may differ in the time courses of their effects on anxiety, rumination, mood, depression, and vigor (p-values < .05, uncorrected). These results suggested that accelerated 5x5 rTMS has a similar efficacy in alleviating 14 depression symptom domains compared to conventional once-daily rTMS, and that either protocol may be appropriate for MDD patients with a variety of symptom profiles.