A course of 'cluster maintenance' transcranial magnetic stimulation (TMS) can induce remission

Objective: Patients suffering major depressive disorder (MDD) who come to transcranial magnetic stimulation (TMS) are prone to relapse. ‘Cluster maintenance’ TMS involves courses of 5 treatments delivered over 2.5-5 days separated by non-treatment periods. Our aim was to determine whether, when patients who have responded to acute TMS and have then received cluster maintenance TMS, but relapse despite this care, might achieve remission via a further 5 treatments.

Method: This was a Quality Assurance/Clinical Audit study of a clustered maintenance service, over a one-year period. We studied the outcome of courses provided to patients who had recently relapsed/partially relapsed, according to the criteria of two rating scales (HAMD6 and CGI-S). In addition, a visual analogue scale for depression and the Sleep Quality Scale were administered.

Results: Remission on both the HAMD6 and CGI-S occurred following 56% of courses, and remission on one occurred following 75% of courses. Large improvements were achieved on both subjective instruments.

Conclusion: During a cluster maintenance TMS program, when relapse occurs, a further 5 treatment course will likely provide remission and improve well-being. Clustered maintenance programs ensure patients are treated regularly – this may explain, in-part, why a small number of treatments can produce high rates of remission.