Personalized Repetitive Transcranial Magnetic Stimulation (PrTMS®) Reduces Major Depressive Disorder (MDD) Symptom Severity
Jacob Shawwa1, Eugenio Reina1, Alan Ho1, Caleigh Roach1, Matthew Kis1, Philip Harvey PhD2, Carl Schulman MD, PhD3
1University of Miami Miller School of Medicine, 2Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 3DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine
Objective:
Evaluate the efficacy of PrTMS as an effective adjunctive treatment for MDD. We hypothesize that PrTMS will significantly reduce MDD symptom severity.
Background:
Altered activity in the brain's default mode network (DMN), reflected in dysregulated alpha oscillations observed in EEG, is one hypothesis for the cause of some MDD subtypes. PrTMS utilizes spectral EEG guidance to iteratively optimize MDD symptom relief through low-power stimulation of multiple cortical areas. Adjustments of cortical treatment sites and stimulus frequency are guided by an algorithm identifying stimulation frequencies within the DMN alpha oscillatory band, targeting functional abnormalities.
Design/Methods:
A retrospective analysis was performed of data collected during PrTMS treatment for MDD. Patients received 20 PrTMS treatments and were categorized based on initial PHQ-9 scores (moderate 10-15; moderately severe 15-19; severe 20-27). Paired t-tests were utilized to determine whether there was statistically significant change from baseline. Demographic variables were assessed for differences using linear regression.
Results:
Mean age was 42±16 years (range: 18-101). Average treatment completion time was 77±57.7 days. 1673 patients (56.9% female; 43.1% male) completed 8365 PHQ-9 questionnaires. Of 713 with severe MDD, a significant decrease in score was observed from 23.9±2.8 to 14.7±7.9 (p<0.001). 68% exhibited improvement to moderately severe or better. Of 497 patients with moderately severe MDD, a significant decrease in score was observed from 17.0±1.5 to 11.0±6.1 (p<0.001). 71% exhibited improvement to moderate or better. Of 463 patients with moderate MDD, a significant decrease in score was observed from 11.9±1.4 to 8.1±5.5 (p<0.001). 87% exhibited improvement to mild and of those, 34% reached remission (PHQ-9<5). No effects of age or gender were observed.
Conclusions:
These data support the use of PrTMS in reducing MDD symptom severity and underscore its potential role in therapeutic outcomes. Questionnaires like PHQ-9 can introduce self-report bias, highlighting the need for prospective, controlled PrTMS studies to substantiate findings.
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