It is well established that transcranial magnetic stimulation (TMS) has a positive therapeutic effect on patients with treatment-resistant depression (TRD). However, patients who have responded to TMS are often unsure how to proceed post-treatment. Is it okay to stop TMS completely?
To answer this question, let’s look at the research on maintenance treatment. Maintenance treatment is an important part of TMS. It involves routine follow-up booster sessions to continue a patient’s wellness and prevent relapse. It can be likened to staying on your antidepressant after your symptoms have resolved in order to stay well.
Research investigating TMS as a maintenance treatment for depression has been encouraging. A study by Rapinesi et al., exploring the role of TMS as a maintenance option in the treatment of bipolar disorder and major depressive disorder, found that patients randomized to the maintenance group had a lower incidence of depressive relapses/recurrences compared to the non-maintenance group. Researchers observed a significant increase in depression scores in the non-maintenance group at the 6- and 12-month follow-up compared to patients who received maintenance. In other words, those who received maintenance treatments continued to feel well more often than did those who stopped TMS completely.
It is also worthwhile pointing out that in this study, patients were allowed to continue their medications, even though the medications had not achieved a full remission of depression. The results therefore support the hypothesis of TMS in combination with medication in the treatment of TRD. That having been said, other research and clinical experience supports that TMS can help patients reduce or stop antidepressants.
Reardon et al. conducted a case series review of patients with major depressive disorder. These patients, who had a history of not responding to medication, showed positive responses to an initial course of TMS. They were then offered maintenance TMS treatment. One out of two patients received marked benefit from maintenance TMS. It is worth mentioning that, according to the authors, patients who responded markedly to the acute treatment phase also tended to benefit most from maintenance TMS.
Moreover, despite the fact that some patients received nearly 1 million pulses over the course of several years, no serious adverse events were reported. (To put this in perspective, a typical TMS course is 36 sessions of 3000 pulses each, or a total of 108,000 pulses.) Thus, with respect to safety and tolerability, this study confirms previous evidence that TMS is very safe. While there is still much headway to be made, the current literature indicates that TMS is a valuable option as a maintenance therapy for TRD, with studies noting fewer cases of relapse in patients who receive maintenance compared to those who do not.
In practice, at Principium Psychiatry we work closely with patients to find the right follow-up treatment for you. Some patients feel very confident after completing TMS, and make a plan to call us if there is any recurrence of symptoms in the future. We may not hear from such patients for a year or more. In other cases, the patient may be worried about stopping TMS and have a history of rapid relapses to depression. In such cases, we may schedule monthly booster sessions in order to help maintain wellness (i.e. maintenance treatment). A typical booster course involves 4-6 treatments every 4 to 8 weeks. TMS treatment is flexible, and it is relatively simple to tailor the treatment to the patient’s unique clinical history and needs.
Principium Psychiatry provides cutting edge TMS treatment at each of our locations. Our offices are located at four convenient locations; two offices in Manhattan, one near Grand Central Station and another office along Wall Street. In addition, we have an office in Greenwich Connecticut and Santa Monica California.
