Background: TMS therapy has been an essential treatment option for patients suffering from TRD. It had been FDA cleared since 2008 and is widely accepted as a treatment option. Unfortunately, the success rate achieved with TMS therapy falls short of being the ultimate solution to TRD. Esketamine (intranasal spray) showed promise for TRD and was FDA approved in 2019. Combining both treatments in tandem, TMS then Esketamine can offer an augmentation treatment protocol to improve outcomes. This study reports retrospective data analysis of Esketamine following transcranial magnetic stimulation in patients with TRD who didn’t respond to TMS therapy alone.
Methods: 13 patients with severe treatment resistant depression (> 4 antidepressants history) and recent non-response to TMS therapy received Esketamine intranasal spray treatment over 2 months. All received at least 8 Esketamine treatments but no more than 12 Esketamine treatments before reassessment. The initial dose of Esketamine was 56 mg. The dosage was increased to 84 mg for all patients except for one because of intolerance. MADRS (primary outcome), PHQ-9, and GAD-7 (secondary outcome) were assessed before TMS, after TMS, and after Esketamine.
Results: 6 patients remitted (MADRS 12 or less), and 6 patients responded (MADRS decreased by 50%) to Esketamine following transcranial magnetic stimulation.
Conclusion: Esketamine following transcranial magnetic stimulation can be effective for TRD patients who don’t show significant clinical response to recent TMS therapy.
Conflicts of Interest: None to report
Funding: Florida TMS Clinic
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