(There was no funding for this study)
      Background: The objective was to measure whether repetitive Transcranial Magnetic Stimulation (rTMS) augmented with psychotherapy, sleep modifications & increased exercise would improve clinical outcomes – when compared to rTMS as a sole treatment modality for patients with Major Depressive Disorder (MDD).
      Methods: Forty-three (43) patients (10 male, 33 female), aged 18-65 years of age, with MDD, severe, recurrent without psychotic features were studied retrospectively in a meta-analysis. Patients underwent 36 rTMS treatments NeuroStar ™ Advanced Therapy on the left dorsolateral prefrontal cortex (120% MT, 5-10Hz in sequences of 40 pulse per 4 seconds with 11 second intervals for 18:45 minutes resulting in a total of 3000 pulses). Treatment occurred 5 times weekly for 6 weeks, and tapering treatments down to 3 treatments on week 7, 2 on week 8, and 1 on week 9. Patients underwent once weekly, skills-based Cognitive Behavioral Therapy (CBT) and Dialectal Behavioral Therapy (DBT), were monitored via clinic provided fitness trackers and the Patient Health Questionnaire (PHQ-9) was administered prior to each treatment, 3 weeks after completing TMS and 3 months after treatment.
      Results: Of the 43 patients treated (10 male, 33 female), 100% of participants completed the full course of 36 treatments. The participants showed greater symptom reductions compared to national averages. The PHQ-9 scale elicits a response defined as reduction of 50% from baseline and remission below 5. This study resulted in a response rate of 89.2% with a remission rate of 68%. NeuroStar Advanced Therapy shows national data response rates at 64% and remission rates at 33%. This data reflects the scales during, post, 3 weeks and 3 months after treatment.
      Conclusions: The addition of psychotherapy, exercise and sleep modifications to rTMS for MDD showed significant symptom reduction, eliciting a higher response and remission rate compared to rTMS alone. There was no randomization of groups however symptom reduction was measured against national response rates where rTMS was utilized alone. These promising initial findings suggest further investigation is warranted.