Of all the people that experience a major depressive episode for the first time, depression will recur in about half of them. Several years may pass before the depression recurs, or it may come back in as little as a couple of weeks. Depression may recur only once or multiple times over the course of one’s life. As far as managing depression, antidepressants are the first-line therapy and are usually prescribed in combination with some form of psychotherapy. Once a person has recovered from a depressive episode it is up to the treating physician to determine whether the patient should receive maintenance treatment. This involves weighing several factors including but not limited to, number of depressive episodes, comorbidities, current life stressors, and family history of depression. As you might expect, maintenance treatment is quite similar to the standard treatment for depression and this was the case for several years — there were very few effective alternatives beyond antidepressants, psychotherapy, or a combination of the two. More recently, however, with the addition of treatments like transcranial magnetic stimulation (TMS) to the stock of interventions used to treat severe depression, other preventive maintenance options are available.
On this subject, Wang et al. – a group of researchers based out of China – sought to evaluate the efficacy of TMS in the prevention of depressive relapse/recurrence. From 2013 to 2015 they conducted a randomized controlled trial with patients experiencing a moderate to a severe depressive episode. Those patients who had achieved partial or full remission were randomized to one of three treatment arms – the TMS group, the antidepressant group, or the TMS + antidepressant group. Using “time to relapse” and “rate of relapse/recurrence” as the two main outcomes, results revealed that TMS alone or in combination with an antidepressant is superior to antidepressant monotherapy for the prevention of relapse and recurrence. Wang et al. observed that both groups containing TMS had lower incidences of relapse/recurrence than the antidepressant group. Participants in the antidepressant group were thus at greater risk of depressive relapse/recurrence as compared with the TMS group and the TMS + antidepressant group.
Along with previous research, the study conducted by Wang et al. demonstrates the preventive efficacy of TMS, either as a monotherapy or as an adjuvant to antidepressants. Based on these results, clinicians should give strong consideration to TMS for the long-term prevention of depressive relapse/recurrence. And finally, although antidepressants are still the mainstay in the treatment of severe depression, considering that noncompliance to long-term antidepressant regimens is a serious problem, TMS provides an attractive alternative to pharmacological treatment.
