Maintenance transcranial magnetic stimulation reduces depression relapse: a propensity-adjusted analysis

J Affect Disord. 2013 Oct;151(1):129-35. doi: 10.1016/j.jad.2013.05.062. Epub 2013 Jun 18.


Background: The effectiveness of repetitive transcranial magnetic stimulation (TMS) is well established while studies of maintenance TMS are lacking. We aim here to determine whether maintenance is associated to a decrease in the relapse rate of depression, following successful acute treatment.

Methods: We enrolled 59 consecutive patients with pharmacoresistant depression who have responded (>50% decrease in symptom severity) up to 6 weeks of acute TMS treatment. These patients received either 20 weeks of maintenance TMS (n=37) or no additional TMS treatment (n=22). We performed propensity adjusted-analysis to examine the association between the relapse rate over this 20-week period and maintenance TMS. Propensity analysis eliminated differences in baseline characteristics between patient with and without maintenance TMS and approximated the conditions of random site-of-treatment assignment.

Results: At 20 weeks, relapse rate was significantly different between the two groups (p=0.004, propensity analysis): 14 patients in the maintenance TMS group (37.8%) vs. 18 in the non-maintenance TMS group (81.8%), with an adjusted Hazard Ratio (HR)=0.288 (0.124-0.669).

Conclusions: Maintenance TMS was associated with a significantly lower relapse rate in patients with pharmacoresistant depression in routine practice among responders.

Keywords: Depression; Maintenance treatment; Repetitive transcranial magnetic stimulation.

Publication types

  • Clinical Trial

MeSH terms

  • Depressive Disorder, Major / prevention & control
  • Depressive Disorder, Major / therapy*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Propensity Score
  • Proportional Hazards Models
  • Secondary Prevention
  • Transcranial Magnetic Stimulation* / methods
  • Treatment Outcome