Deep TMS H1 Coil treatment for depression: Results from a large post marketing data analysis

• Published in: Psychiatry research 2023-06, Vol.324, p.115179-115179, Article 115179
• Main Authors: Tendler, Aron, Goerigk, Stephan, Zibman, Samuel, Ouaknine, Salomé, Harmelech, Tal, Pell, Gaby S, Zangen, Abraham, Harvey, Steven A., Grammer, Geoffrey, Stehberg, Jimmy, Adefolarin, Oluremi, Muir, Owen, MacMillan, Carlene, Ghelber, Diana, Duffy, Walter, Mania, Irakli, Faruqui, Zeeshan, Munasifi, Faisal, Antin, Todd, Padberg, Frank, Roth, Yiftach
• Format: Article
• Language: English
• Subjects: Deep TMS; Depression; Depression - therapy; Depressive Disorder, Major - therapy; Humans; Mixture modeling; Phase four; Predictors; Prefrontal Cortex; Real world evidence; rTMS; Transcranial Magnetic Stimulation - methods; Treatment Outcome
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2023.115179

•Thirty Deep TMS treatments have an 82% response and 65% remission rate.•Remission rates were 72% with the HDRS, a clinician rated scale.•Median amount of treatments(days) for sustained response were 16(21days).•Higher stimulation intensity relative to individual MT predicted superior outcomes.•1800 pulses of iTBS at 80–90%MT had similar efficacy to 1980 pulses 18 Hz at 120%MT. Phase IV study evaluated Deep TMS for major depression in community settings. Data were aggregated from 1753 patients at 21 sites, who received Deep TMS (high frequency or iTBS) using the H1 coil. Outcome measures varied across subjects and included clinician-based scales (HDRS-21) and self-assessment questionnaires (PHQ-9, BDI-II). 1351 patients were included in the analysis, 202 received iTBS. For participants with data from at least 1 scale, 30 sessions of Deep TMS led to 81.6% response and 65.3% remission rate. 20 sessions led to 73.6% response and 58.1% remission rate. iTBS led to 72.4% response and 69.2% remission. Remission rates were highest when assessed with HDRS (72%). In 84% of responders and 80% of remitters, response and remission was sustained in the subsequent assessment. Median number of sessions (days) for onset of sustained response was 16 (21 days) and for sustained remission 17 (23 days). Higher stimulation intensity was associated with superior clinical outcomes. This study shows that beyond its proven efficacy in RCTs, Deep TMS with the H1 coil is effective for treating depression under naturalistic conditions, and the onset of improvement is usually within 20 sessions. However, initial non-responders and non-remitters benefit from extended treatment.