One Hundred Courses of Cluster Maintenance Transcranial Magnetic Stimulation (CM TMS)—A Clinical Audit Study

Objective

Major depressive disorder (MDD) which comes to transcranial magnetic stimulation (TMS) is prone to relapse. Cluster maintenance (CM) TMS is courses of 5 treatments delivered over 2.5–5 days, separated by monthly or greater non-treatment periods. Our aim was to characterize the outcomes of 100 courses of CM TMS.

Method

This was a Quality Assurance/Clinical Audit study. We studied consecutive CM TMS courses provided to private hospital inpatients. Mood was rated (on admission and discharge) using the six-item Hamilton depression rating (HAMD6) and the Clinical Global Impression – Severity (CGI-S) scales. We also applied recent STAR*D criteria which are designed to measure the ‘clinical change’ expected to impact patient function [16].

Results

For the total sample, using the HAMD6, 83% of courses featured relapse or partial relapse on admission, and 81% featured remission on discharge. Of 46 courses featuring HAMD6 relapse on admission, 74% featured remission on discharge. For the 100 courses the HAMD6 discharge scores were significantly lower than the admission scores (p = 2.0 × 10 –24 ), as were the CGI-S scores (p = 1.8 × 10 –25 ). Using STAR*D criteria for people in relapse or partial relapse on admission, CM TMS provided least a ‘clinically meaningful’ outcome in 82% of the cases.

Conclusion

For courses featuring relapse or partial relapse on admission, CM TMS converted greater than 70% to remission at discharge. It produced statistically significant reductions in HAMD6 and CGI-S scores, and using STAR*D criteria, at least ‘clinically meaningful’ change was extensively demonstrated. This evidence indicates CM TMS should be readily available to people living with relapsing MDD.