Background: Tiredness is used in some characterizations of major depressive disorder (MDD). Transcranial magnetic stimulation (TMS) lowers all symptoms of MDD.

Objective: To explore whether, 1) a visual analogue scale (VAS) for tiredness is a valid and reliable measure of a feature of MDD, and 2) TMS treatment reduces subjective tiredness occurring in MDD.

Method: A naturalistic study of treatment with 10 Hz TMS. Completed pre- and post-treatment: HAMD-6, a visual analogue scale (VAS-6), the Clinical Global Impression – Severity (CGI-S) and a ‘VAS-tiredness’. Two groups received TMS. Acute course: N=52 participants suffering acute MDD, received 20 treatment courses (total courses 86). Relapse prevention (RP) course: N=26 participants suffering chronic relapsing MDD received scheduled episodic courses over 3 days; (total courses 266). VAS-tiredness scores were compared with the standardized tool results.

Results: There were significant medium to large correlations between pre- and post-treatment VAS-tiredness and the standard depression measures (HAMD-6 .406 to .447, VAS-6 .446 to .525, CGI-S .348 to .407; all p<.001). TMS treatment produced a significant reduction in VAS tiredness in both (Acute course and RP) groups (main effect: F(1,350)=147.3, p<.001, η2=.30). The two groups displayed difference in the pre-treatment VAStiredness with the Acute group having higher scores pre-treatment. Post-treatment tiredness scores were similar.

Conclusion: -tiredness is a valid measure of a feature of MDD. VAS-tiredness provides potentially useful information and complements standard mood tools. TMS treatment can reduce tiredness in MDD.