New data has recently been published providing compelling evidence that clinicians should consider repetitive transcranial magnetic stimulation (TMS) much earlier for patients who do not respond to antidepressant medication. The study focused on 278 individuals with treatment-resistant depression, defined as depression unresponsive to at least two antidepressant medications during their current depressive episode.
Participants were randomly assigned to one of three treatment strategies: 1) switching to the antidepressant venlafaxine XR (or duloxetine if more suitable), 2) adding the atypical antipsychotic medication aripiprazole, or 3) beginning TMS therapy. The Montgomery-Asberg Depression Rating Scale (MADRS) was employed to measure outcomes, a standard metric for evaluating the efficacy of antidepressant treatments. Both medication doses and TMS application (delivered via 10Hz pulses to the left frontal cortex) followed standard protocols.
In primary assessments, TMS significantly outperformed venlafaxine XR in improving MADRS scores. Response rates were notably higher with TMS (52.2%) compared to venlafaxine XR (35.8%) and aripiprazole (38.1%). While these figures were not statistically compared across all three groups simultaneously, the trend favors TMS.
Regarding safety, TMS exhibited a lower incidence of adverse events (39.3%) compared to venlafaxine XR (49.5%) and aripiprazole (57%). This finding supports earlier studies suggesting that TMS is not only effective but also generally well-tolerated and safer than other treatment options.
The ASCERTAIN-TRD trial and similar studies reinforce the outdated nature of resistance to TMS and provide substantial reassurance to clinicians, patients, service providers, and third-party payers of its safety and efficacy as a treatment option.
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