Synchronized Transcranial Magnetic Stimulation Useful in Acute Depression

Transcranial magnetic stimulation
Transcranial magnetic stimulation
Investigators observed individuals with more severe depression and anxiety had greater response to active synchronized transcranial magnetic stimulation (sTMS) whereas individuals who had never received treatment demonstrated a greater response to sham.

Active synchronized transcranial magnetic stimulation (sTMS) has shown better efficacy among individuals with more severe depression and anxiety, according to study results recently published in Depression and Anxiety. Those who were treatment-naive showed a better response to sham treatment.

This sham-controlled, double-blind trial included 120 participants with at least moderate depression who were not taking medication, 59 of whom received 6 to 8 weeks of sTMS and 61 of whom received corresponding sham treatment.

Univariate and stepwise linear regression were used to identify sTMS response predictors at 6 weeks of treatment, including sex, age, number of unsuccessful antidepressant regimens in the current episode of depression, anxiety comorbidity, acuteness of major depressive disorder, individual alpha frequency, and acuteness of anxiety. For comparison, 83 participants also underwent an open/active continuation period for 4 weeks after the double-blind trial.

Active sTMS was more effective among individuals with more severe depression (β=−0.78; <.001) and anxiety (β=−1.27; <.001) at baseline, indicated by a greater decrease at week 6 in the 17-item Hamilton Rating Scale of Depression (HAMD17) score.

To account for possible collinearity between anxiety and total HAMD17 score, HAMD17 scores excluding anxiety items were calculated and revealed a similar relationship between acute depression and efficacious sTMS (=.007). Treatment naivety, including fewer unsuccessful antidepressant treatments, was associated with improvement in the sham group (<.001). A lower individual alpha frequency was associated with lower efficacy among those undergoing active sTMS for 10 weeks (=.001).

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The study researchers conclude: “[G]reater depressive symptom severity and comorbid anxiety predicted clinical improvement with sTMS, whereas sham response was associated with less treatment resistance. While the efficacy of sTMS in more severely ill [major depressive disorder] patients with comorbid anxiety patients should be prospectively examined, these results indicate that sTMS has a different efficacy profile from standard rTMS and may represent an important new treatment option when considering the care of patients with treatment-resistant [major depressive disorder].”

Several authors report funding and association with pharmaceutical companies. For a full list of disclosures, see the reference.


Philip NS, Leuchter AF, Cook IA, Massaro J, Goethe JW, Carpenter LL. Predictors of response to synchronized transcranial magnetic stimulation for major depressive disorder [published online November 27, 2018]. Depress Anxiety. doi: 10.1002/da.22862