Major Depressive Disorder (MDD) is a complex and often recurrent condition that affects millions of people worldwide. While treatments such as antidepressant medications and psychotherapy have proven effective for many, a significant portion of patients either do not respond to these interventions or experience relapse after initial improvement.
Since being approved by the FDA in 2008, Transcranial Magnetic Stimulation (TMS) has emerged as a groundbreaking non-invasive brain stimulation therapy for treatment-resistant Depression (TRD). TMS uses magnetic fields to stimulate specific brain regions involved in mood regulation, offering new hope for individuals who struggle with traditional treatment options.
While the efficacy of acute TMS treatment—a structured course of daily sessions over 6-8 weeks—has been well-established, an important question remains: Can ongoing maintenance TMS help sustain the benefits and prevent relapse?
A recent systematic review published in the Journal of Personalized Medicine (MDPI) explores this very question, analyzing multiple studies to determine whether maintenance TMS protocols can effectively reduce relapse rates in MDD patients. Let’s break down the key findings and what they mean for the future of Depression treatment.
What Is Maintenance TMS?
Once a patient completes an initial acute TMS treatment, some experience prolonged remission from depressive symptoms. However, others may relapse within months, much like those who discontinue antidepressant medication after achieving symptom relief.
Maintenance TMS refers to a follow-up treatment strategy in which patients receive TMS sessions periodically after the acute phase to sustain therapeutic benefits. These sessions are spaced out over weeks or months rather than administered daily, to prevent relapse before it occurs.
This approach aligns with strategies used in pharmacological treatments, where long-term antidepressant use helps prevent symptom recurrence. However, maintenance TMS is still an emerging concept, and researchers are working to determine the best protocols for long-term success.
Key Findings from the Systematic Review
The systematic review analyzed 14 studies examining maintenance TMS in MDD patients. Here’s what the research revealed:
1. Maintenance TMS Can Reduce the Risk of Relapse
The majority of studies indicated that patients who continued with maintenance TMS after an initial positive response to acute treatment experienced lower relapse rates compared to those who discontinued treatment. This suggests that maintenance TMS could serve as a viable long-term intervention to sustain improvements in mood and mental health.
2. No Universal Protocol—But Frequency Matters
One of the biggest challenges identified in the review is that there is no standardized protocol for maintenance TMS. Different studies used varying session frequencies, stimulation intensities, and treatment durations.
However, one critical finding stood out: Patients who received two or fewer TMS sessions per month generally did not maintain the benefits of acute TMS. This suggests that infrequent maintenance treatments may not be sufficient to prevent relapse.
3. The “Five-Month Relapse Window”
Several studies noted that the highest risk of relapse tends to occur around five months after the initial acute TMS treatment. This finding suggests that the first few months post-treatment are crucial, and maintenance TMS may be most beneficial during this period.
4. Individualized Treatment Approaches Are Needed
The review emphasized the importance of personalized TMS protocols, as different patients respond to different frequencies and durations of maintenance treatment. More research is needed to determine the optimal balance between treatment intensity and long-term effectiveness.
What This Means for Depression Treatment
These findings provide valuable insights into how we can optimize TMS treatment for individuals with MDD. While acute TMS is already an FDA-approved and widely used treatment for Depression, incorporating maintenance TMS could revolutionize long-term care for patients who respond well to initial treatment.
Potential Benefits of Maintenance TMS:
- Reduced Relapse Rates – Prevents depressive episodes from returning after initial symptom relief.
- Non-Invasive Alternative – Provides a drug-free option for those who struggle with medication side effects.
- Long-Term Mood Improvement – Helps maintain emotional balance without the need for daily interventions.
Challenges That Need to Be Addressed:
- No Standardized Protocols – More research is needed to determine the ideal frequency, duration, and intensity of maintenance TMS.
- Limited Accessibility – Maintenance TMS treatments may not be covered by all insurance plans.
- Individual Variability – Not all patients respond the same way to maintenance TMS, requiring personalized treatment adjustments.
What’s Next for Maintenance TMS Research?
While the current research suggests promising results, there is still much to learn about the long-term effects of maintenance TMS. Future studies should aim to:
- Standardize treatment protocols to determine the optimal frequency and duration for sustained benefits.
- Explore the neurological mechanisms behind TMS to refine personalized treatment strategies.
- Improve accessibility and affordability to make maintenance TMS a viable option for more patients.
The integration of TMS into mainstream Depression treatment is already a major step forward, but refining maintenance protocols could provide an even greater breakthrough for those struggling with recurrent Depression.
Final Thoughts: Is Maintenance TMS the Future of Depression Treatment?
The evidence so far suggests that maintenance TMS has the potential to significantly reduce relapse rates in MDD patients, especially when administered at an appropriate frequency.
For individuals who respond well to acute TMS, continuing with periodic maintenance sessions could be a game-changer, providing sustained relief without the long-term side effects of medications.
However, more research is needed to establish best practices and ensure that maintenance TMS is both accessible and effective for a broad range of patients.
As mental health treatment continues to evolve, TMS represents an exciting frontier that may offer lasting relief for those battling Depression.
Want to Learn More?
If you’re interested in exploring TMS as a treatment option, contact Mid City TMS since we have over 15 years of specializing in neuromodulation therapies. We can help determine whether TMS—or maintenance TMS—is the right approach for you.
Sources:
- Babygirija, R., Kumar, S. S., Koga, Y., Mahalakshmi, A. M., Mukaisho, K., & Perumal, N. (2023). Transcranial magnetic stimulation for psychiatric disorders: A comprehensive review. Journal of Personalized Medicine, 13(4), 697. https://www.mdpi.com/2075-4426/13/4/697
- U.S. Food and Drug Administration. (2018, August 17). FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder