Long-term outcomes following randomized rTMS or antidepressant treatment: A twelve-month naturalistic follow-up

Introduction: Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for depression of which the acute and short-term effects have been studied extensively. However, much less is known about the long-term effectiveness of rTMS. This paper aims to investigate the long-term effects of rTMS and antidepressant medication in patients with moderate treatment-resistant depression (≥2 treatment trials). Methods: Naturalistic follow-up data was collected for twelve months as part of a clinical trial comparing rTMS and antidepressant medication. Response and remission based on the Hamilton Depression Rating Scale (HDRS-17) were calculated for both groups at end of treatment, as well as at four-, six-, nine- and twelve-months follow-up. Furthermore, the sustained effects of both treatments on anxiety, anhedonia, and rumination were investigated. Results: At the end of treatment, response and remission rates were higher in the rTMS group (40.9% and 29.5%) than in the medication group (18.8% and 6.3%). 69% of the patients in the medication group received treatment with rTMS at some point during the follow-up period. Response and remission remained relatively stable over 12 months in both groups. Sustained response was observed in the majority of rTMS and medication responders for whom data was available for the full follow-up period. Conclusion: Our findings provide insights into the naturalistic long-term effects of rTMS and antidepressant medication in patients with moderate treatment-resistant depression.