Psychotherapy and psychopharmacology utilization following repetitive transcranial magnetic stimulation (rTMS) in patients with major depressive disorder

Lifetime prevalence of major depressive disorder (MDD) among a sample of adults in the United States has been reported as over 16%. Repetitive transcranial magnetic stimulation (rTMS) has become a treatment option for a subset of treatment-refractory patients with MDD. In a population of 159 commercial health plan individuals, we used claims data to compare utilization of antidepressants, antipsychotics, and psychotherapy during the one-year time period prior to rTMS initiation to the one-year time period starting 60 days after rTMS initiation. Both antidepressant and antipsychotic use declined significantly from three months pre-rTMS compared to each of four quarterly post-rTMS time points. Psychotherapy utilization also significantly declined post-rTMS compared to pre-rTMS. The reduction in medication utilization could reflect clinical improvement of the study population, and the absence of even greater reductions in utilization likely reflects the lack of clinical guidelines for antidepressant prescribing in the aftermath of rTMS treatment.