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Background: Major depressive disorder (MDD) is frequently chronic and relapsing. The use of maintenance or continuation transcranial magnetic stimulation (TMS) has received clinical and some research support. Objective: To conduct a case series study to report the outcomes of once-weekly (OW) or once-fortnightly (OF) continuation TMS in a real-life setting. Methods: We offered OW or OF TMS sessions to patients with MDD in remission or partial remission/relapse. Results: Ten patients received OW TMS and four received OF TMS, for 8 to 46 weeks. No patients in either group who were in remission or partial remission at baseline experienced a relapse. Improvements in HAMD6 and CGI-S scores were statistically significant or of borderline significance for the total sample and the OW group. Conclusions: This naturalistic, open-label observational study indicates that OW TMS is effective as maintenance therapy in MDD, while also offering some support for OF TMS maintenance in preventing relapse. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of clustered maintenance transcranial magnetic stimulation (TMS) on irritability occurring in treatment-resistant major depressive disorder (MDD).Method: A naturalistic study of 106 courses that includes pre- and posttreatment assessments of subjective and objective depression and a subjective measure of irritability developed for this study.Results: Forty-six participants (35 females), mean age 43.2 years (14.3), completed 106 courses. There was a significant reduction in irritability and depression scores (p < .001). The change in irritability scores was significantly correlated with the change in depression scores, r = .40, p < .001.Conclusion: TMS has the capacity to reduce the irritability co-occurring with treatment-resistant MDD, known to be responsive to TMS. This increases the possibility of using TMS in the treatment of irritability co-occurring with other disorders or standing alone (should irritability be categorized as a stand-alone disorder). [ABSTRACT FROM AUTHOR]

Background: Various TMS protocols have been described, none is appropriate in all circumstances. Objective: To describe the response of a person with acute MDD treated with TMS who was only available for treatment on 3 consecutive days per week. Method: 5 treatment sessions were provided over 3 days – this was provided 4 times, separated by no-treatment periods of 4 days. HAMD6, CSI-S and VAS for depression were completed on the first and last day of each 3-day treatment series. Results: Remarkable improvement; the HAMD6 fell from 12 (severe depression) to 0, the CGI-S fell from 5 (Markedly ill) to 1 (Normal, not mentally ill) and the VAS fell by 98%. There was clear improvement during the last 3 treatment series, as well as during all 3 no-treatment periods. Conclusion: Should these findings be replicated, an additional, useful protocol may be established. [ABSTRACT FROM AUTHOR]

Objective: Transcranial magnetic stimulation is an emerging treatment of treatment-resistant depression. Current protocols rely on daily treatments. This study was designed to determine whether the time period over which treatment is delivered is an important factor in efficacy. Method: Sixteen adult patients with treatment-resistant major depression were randomly assigned to one of the two treatment groups, both of which received 2 weeks of treatment. One group received daily treatment (10 treatments, on business days). The other group received three treatments in week one, and two treatments in week two (five treatments, on spaced business days). Mood was rated using the Hamilton Depression Rating Scale (HDRS) and a self-rated visual analogue scale. Response was defined as a 50% reduction in HDRS rating, and remission was defined as achieving an HDRS score of 8 or less. The groups were compared throughout the 2-week study period. Results: At entry, there were no demographic differences between the groups. Multivariate tests showed a significant main effect for time (Pillai trace = 0.76, F(4,56) = 8.56, p < 0.001, power = 0.99) reflecting the improvement in both measures of depression during treatment. There was no significant difference between the groups overall (Pillai trace = 0.25, F(2,13) = 2.12, p = 0.16, power = 0.36). Additionally, there was no significant interaction between time and treatment group (Pillai trace = 0.18, F(4,56) = 1.35, p = 0.26, power = 0.39) indicating that the significant improvement in depression over time was similar for both treatment groups. There were no significant differences in response and remission rates between the groups. Conclusion: The time period of treatment appeared to be an important outcome factor. This suggests that less than daily transcranial magnetic stimulation treatment may be a useful clinical alternative. [ABSTRACT FROM AUTHOR]

Less than half of those suffering major depressive episodes achieve remission with the first antidepressant provided and one-third of all patients suffering depression have a chronic condition. Clinical experience indicates that a substantial proportion of patients suffer treatment-resistant depression (TRD). Our aim is to explore the literature reporting the drug treatment of TRD, and to present such information as would be of interest to clinical psychiatrists. Literature searches were conducted using PubMed and entering the words antidepressant, augmentation, combined antidepressants, treatment resistant depression and the names of individual antidepressant medications. Most authors recommended that TRD should be first approached by reassessing the diagnosis, adding psychotherapy and attending to psychosocial factors. Details of the following pharmacological options were identified: (i) augmentation of the currently employed antidepressant with a medication which is not an antidepressant; (ii) change of antidepressant; and (iii) addition of a second antidepressant to the current antidepressant, or commencement of a combination of two antidepressants. When monotherapy provided at the maximum manufacturer-recommended doses for 3−4 weeks has failed to provide remission in depression, the diagnosis should be confirmed, psychotherapy added and psychosocial factors should receive attention. In the sustained absence of remission, a better outcome may be obtained by augmenting the antidepressant, changing from a single-action to a double- or multiple-action drug, or by combining antidepressants. [ABSTRACT FROM AUTHOR]