Typical Response & Remission Rates of rTMS in Treatment Resistant Cases – Dr. Martijn Arns
Dr Sanil Rege, Consultant Psychiatrist and Founder of Psych Scene and Psych Scene Hub speaks to Dr. Martijn Arns, Chief Scientific Adviser, neuroCare Group; Founding Director & Senior Researcher at Research Institute Brainclinics.
Author Quote :
Response rates (with rTMS) are roughly 40-60% and remission rates are roughly around 35-40%. If you match that to the different stages in the STAR*D trial, that would be equivalent to being superior after one medication failure. We found in a total sample of 200 patients, that the remission rate is about 55% and the response rate is about 2/3 rds (66%) (in combined TMS and psychotherapy).
When you are putting you patient in a chair and you apply TMS, talk to the patient and apply psychotherapy. It might do your patient a favour and enhance clinical response.
Take Home Messages :
- Research has shown that depression is linked to disrupted communication in a specific network of brain structures including the frontal cortex (dorsolateral prefrontal cortex (DLPFC)) and the deeper anterior cingulate (ACC).
- Response and remission rates for rTMS with personalised psychotherapy as a combined treatment in treatment-resistant depression, are higher than for rTMS as a monotherapy.
- rTMS to the DLPFC and endogenous activation of subgenual anterior cingulate through psychotherapy could act as a double booster which may explain the higher efficacy of combined rTMS and psychotherapy.
Combining rTMS and PT resulted in a 66% response and a 56% remission rate at the end of treatment with 60% sustained remission at follow-up. No differences were found between the 10 Hz and 1 Hz TMS regarding clinical outcome.