Maintenance TMS in Treatment Resistant Depression

Summary

Electroconvulsive therapy (ECT) is one of the most efficacious treatments available for treatment-resistant depression (TRD). Although a maintenance ECT protocol exists, multiple barriers limit its use for long-term use. These barriers include procedure tolerability, cognitive side effects, financial burden, and unreliable social support to accompany patients for these treatments. On the other hand, a different modality of noninvasive neuromodulation called transcranial magnetic stimulation (TMS) can be performed in the outpatient setting and does not need anesthesia. The likelihood of cognitive adverse effects with TMS is much lower than with ECT. Our clinical question encompasses piloting a maintenance TMS regimen to maintain remission in treatment-resistant major depressive disorder. This will be a patient-preference clinical trial, with patients offered the choice to initiate maintenance TMS versus maintenance ECT after their index ECT sessions for treatment-resistant depression. There will be no randomization or placebo involved in this study.

Eligibility

Inclusion Criteria:

* Patients treated for TRD who have achieved remission through an index series of ECT
* Able to provide informed consent
* Age between 18 and 65 years
* Deemed appropriate for maintenance TMS by their psychiatrist
* Right-handed

Exclusion Criteria:

* History of seizures or a seizure disorder
* Related neurological disorder, or any other medical condition that would preclude TMS treatment determined by the treatment team.

Conditions2

Locations1 site

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