FOLLOW-UP AFTER COMPLETION OF TRANSCRANIAL MAGNETIC STIMULATION COURSE
These Recommendations on Preservation TMS were produced by the Clinical Standards Committee and supported by the CTMSS Board of Directors.
\Source: Clinical TMS Society: https://www.clinicaltmssociety.org/news/2023-03/preservation-tms-recommendations-clinical-tms-society
The Clinical TMS Society recommends the following strategies for patients being treated for Major Depressive Disorder (MDD) that have had a successful response (i.e., ≥50% improvement in a standardized depression rating scale) to an acute course of Transcranial Magnetic Stimulation (TMS) treatment.
Based on the currently available evidence and treatment options available, the Clinical TMS Society’s Clinical Standards Committee recommends the following approach be considered.
Patients should be periodically monitored for recurrence of depressive symptoms after successful TMS.
Those patients who have a return of significant depressive symptoms (i.e., impacting the patient’s function and measurable increase in standardized rating scale) should be considered for another acute course of TMS. As with the prior acute course, treatment with TMS should attempt to achieve the best possible wellness – ideally remission of symptoms.
If the patient relapses after < 1 year of a successful course of TMS for MDD (i.e., ≥ 50% improvement by rating scale):
repeat an acute course of TMS to the best wellness, then
consider implementing preservation TMS (see below)
If the patient relapses after > 1 year of a successful course of TMS for MDD (i.e., ≥ 50% improvement by rating scale):
repeat an acute course of TMS to best wellness, then
continue to monitor without preservation TMS
Preservation TMS is defined as TMS treatments used to sustain a clinical response after a successful acute course of treatment. Two of the most commonly reported preservation TMS strategies in the literature include:
Cluster of treatments (e.g., 5 treatments over 2 days) once every month
Single daily treatments with a gradually tapering schedule to maximal duration between treatments in which the clinical effect is preserved (e.g., 1 treatment every week for 1 month, 1 treatment every 2 weeks for 2 months, 1 treatment every month for 3 months, etc.)
The safety of preservation TMS is supported by a recent review of Preservation TMS that included 1,494 participants.
When to discontinue preservation TMS due to a lack of clinical effectiveness is not well defined in the literature. A reasonable approach is to discontinue preservation TMS when it clinically fails to adequately control depressive symptoms (i.e., significant return of depressive symptoms and/or functional impairment as defined by rating scales or clinical judgement).
Although we have research supporting clinical effectiveness of using Preservation TMS, these findings are, however, largely based on uncontrolled studies. A critical need exists for research funding agencies and device companies to invest in studies testing how best to maintain the wellness of patients suffering from depression who have responded to an acute course of TMS.
Reference:
Wilson S, Croarkin PE, Aaronson ST, Carpenter LL, Cochran M, Stultz DJ, Kozel FA. Systematic Review of Preservation TMS that includes Continuation, Maintenance, Relapse-prevention, and Rescue TMS. Journal of Affective Disorders. 2022; 296: 79-88.
Approved by the CTMSS Executive Committee on 07.11.22
