Naturalistic findings from an rTMS clinic for the treatment of depressive disorders, in a public health setting

Brain Stimulation, , Vol.8(2) Introduction In conjunction with an rTMS research program conducting clinical trials since 2005, the North Metropolitan Mental Health Service established an “rTMS depression treatment clinic” in Perth in July 2011. We describe the operation of the rTMS service and provide naturalistic assessment of a public service based use of rTMS for treatment of depression. Methods The referral and assessment process are described. Pooled data from all referrals were analyzed. Results Referrals were predominantly from private psychiatrists of patients suffering from treatment-resistant depression. The standard treatment was for 4 weeks but subject to extension. Assessments of efficacy were based on Hamilton Depression Rating Scale (HDRS-21) and Beck’s Depression Inventory-II (BDI) scores at baseline, two weeks, and final. Additional assessments included EEG monitoring and the Repeatable Battery for Neuropsychological Assessment (RBANS). From 179 referrals, 113 patients completed sufficient sessions (2 weeks ITT) for analysis. 45 gained clinical improvement and 34 reached remission. The average improvement was 35.6±34%. There was a significant difference in HamD (t=8.2,p< 0.01) and BDI (t=6.92,p<0.01) with an Effect Size (ES) of 1.09. Four patients received maintenance rTMS and 2 “bilateral” rTMS with varied outcome. The rTMS treatment was generally well tolerated with no major side effects reported. Features that likely reflect severity of the illness, a history of suicidality or previous ECT treatment and previous rTMS, all had lower ES (∼0.8). Features that may be considered exclusion criteria (anxiety or bipolar features), are actually good prognostic indicators with the highest ES values (∼1.25). Features of miscellaneous psychiatric disorders as a group showed an ES at the lower end of the range (∼0.7). Discussion rTMS is a safe and effective treatment for depressive disorders and an rTMS service can be effectively delivered in a research format and a public health setting.