Effectiveness of TMS in treatment-resistant depression 1

Effectiveness of TMS in treatment-resistant depression

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Effectiveness of TMS in treatment-resistant depression 2

Introduction

Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique

that uses a magnetic field to stimulate nerve cells in the brain. It has been studied extensively as

a potential treatment for depression and is gaining popularity as an effective treatment for

treatment-resistant depression (TRD) (Stultz et al., 2020). In this discussion, the effectiveness of

TMS in treating TRD will be analyzed based on research conducted over the past few years. The

research analyzed will include studies that compare TMS to standard care, another intervention,

or a placebo to assess its efficacy in treating TRD. The findings of this discussion will be used to

determine if TMS is an effective treatment for TRD. This paper will also provide

recommendations and implications of the effectiveness of TMS in treating resistant depression.

A synthesized matrix (see appendix below) will be used to organize the information provided

into three main ideas and themes recurring from the chosen five works of literature. The main

idea identified from this topic is that the effectiveness of transcranial magnetic stimulation plays

a significant role in managing individuals' resistant depression.

Resistant Depression Treatment

Treatment-resistant depression is depression that has not responded to two or more

antidepressants. TRD is a severe condition that can lead to long-term disability, and effective

treatments are needed (Gaynes et al., 2020). The research analyzed showed that TMS is an

effective treatment for treatment-resistant depression. Mehta et al. (2022) found that more high-

frequency TMS reduced suicidality in patients with TRD than other antidepressants. Croarkin et

al. (2021) found that left prefrontal TMS was significantly more effective than sham treatment in

reducing depressive symptoms in patients with TRD. Seewoo et al. (2022) showed that TMS was
Effectiveness of TMS in treatment-resistant depression 3

associated with improved emotion regulation and functional connectivity in adults with TRD.

Lastly, Somani and Kar (2019) found that TMS effectively reduced depressive symptoms in

patients with TRD. These findings suggest that TMS is an effective treatment for TRD. Also, it

has fewer side effects than antidepressant medications and is an attractive option for those

resistant to traditional therapies.

Impact of TMS: Evidence for Its Efficacy in Treating Treatment-Resistant Depression

The evidence from the research studies suggests that TMS is an effective treatment for

TRD. The results of the studies showed that TMS was associated with reduced depressive

symptoms, improved emotion regulation, and improved functional connectivity in patients with

TRD.

Additionally, Chang et al. (2020) found that TMS had a positive effect on patients with

TRD even after the treatment had stopped, suggesting that the results of TMS are long-lasting.

These findings indicate that TMS is an effective treatment for TRD and can be used as a viable

option for patients who are not responding to standard therapies.

Nursing Recommendations and Implications

Based on the evidence, TMS appears to be an effective treatment for treatment-resistant

depression. Nurses should be aware of this treatment option and be able to provide information

to patients who may be interested in pursuing TMS as a treatment option. Nurses should also be

able to identify potential risks associated with TMS, such as seizures and headaches, and take

steps to minimize these risks.

Effectiveness of TMS in treatment-resistant depression 4

Nurses should also be aware of the cost associated with TMS treatment and encourage

patients to discuss this with their insurance provider to determine coverage. Additionally, they

should know the side effects related to TMS and provide patients with resources to help them

manage these side effects. Finally, nurses should know the potential for relapse and encourage

patients to continue with other treatments, such as cognitive behavioral therapy, to help them

manage their depressive symptoms.

Conclusion

In conclusion, the evidence suggests that TMS is an effective treatment for resistant

depression. The analysis showed that TMS was associated with reduced depressive symptoms,

improved emotion regulation, and improved functional connectivity in patients with TRD.

Additionally, the effects of TMS were long-lasting, suggesting that it can be used as a viable

treatment option for patients who are not responding to standard treatments. Thus, TMS should

be considered as a potential treatment for TRD. However, physicians should be aware of several

side effects and potential risks to ensure TMS administration is practical and high-quality care is

given to the affected patients.

 Effectiveness of TMS in treatment-resistant depression 5

References

Chang, J., Chu, Y., Ren, Y., Li, C., Wang, Y., & Chu, X. P. (2020). Maintenance treatment of

transcranial magnetic stimulation (TMS) for treatment-resistant depression patients

responding to acute TMS treatment. International Journal of Physiology,

Pathophysiology and Pharmacology, 12(5), 128.

Croarkin, P. E., Elmaadawi, A. Z., Aaronson, S. T., Schrodt Jr, G. R., Holbert, R. C., Verdoliva,

S., ... & Strawn, J. R. (2021). Left prefrontal transcranial magnetic stimulation for

treatment-resistant depression in adolescents: a double-blind, randomized, sham-

controlled trial. Neuropsychopharmacology, 46(2), 462–469.

Gaynes, B. N., Lux, L., Gartlehner, G., Asher, G., Forman‐Hoffman, V., Green, J., ... & Lohr, K. N.

(2020). Defining treatment‐resistant depression. Depression and anxiety, 37(2), 134-145.

Mehta, S., Downar, J., Mulsant, B. H., Voineskos, D., Daskalakis, Z. J., Weissman, C. R., ... &

Blumberger, D. M. (2022). Effect of high frequency versus theta‐burst repetitive

transcranial magnetic stimulation on suicidality in patients with treatment‐resistant

depression. Acta Psychiatrica Scandinavica, 145(5), 529-538.

Seewoo, B. J., Rodger, J., Demitrack, M. A., Heart, K. L., Port, J. D., Strawn, J. R., & Croarkin,

P. E. (2022). Neurostructural Differences in Adolescents With Treatment-Resistant

Depression and Treatment Effects of Transcranial Magnetic Stimulation. International

Journal of Neuropsychopharmacology.
 Effectiveness of TMS in treatment-resistant depression 6

Somani, A., & Kar, S. K. (2019). Efficacy of repetitive transcranial magnetic stimulation in

treatment-resistant depression: the evidence thus far. General Psychiatry, 32(4).

Stultz, D. J., Osburn, S., Burns, T., Pawlowska-Wajswol, S., & Walton, R. (2020). Transcranial

magnetic stimulation (TMS) safety concerning seizures: A literature review. Neuropsychiatric

disease and treatment, 16, 2989.

 Effectiveness of TMS in treatment-resistant depression 7

Research Question: What is the effectiveness of Transcranial Magnetic Stimulation (TMS)

in treating adults with treatment-resistant depression?

Source #1 Source #2 Source #3 Source #4 Source #5

Mehta et al. Croarkin et Seewoo et al. Somani, & Kar, Chang et al.

(2022). al. (2021). (2022) (2019 (2020)

Main Idea A -TMS is an - The authors - Transcranial -This research - This study

effective conducted a Magnetic shows that TMS found that TMS

TMS is effective in
treatment for double-blind, Stimulation is an effective effectively
TRD.
treatment- randomized, (TMS) is an treatment for treated TRD

resistant sham- effective TRD, with patients who had

depression controlled trial treatment for significant responded to an

(TRD). The which found patients with reductions in acute TMS

authors of this that TMS is a Treatment- depressive treatment (p.

study safe and Resistant symptoms such 128).

conducted effective Depression ( p. as sadness,

- In the study,
research that treatment for 462). anxiousness, and
the effects of
compared the individuals suicidal thoughts
- TMS has TMS were
effects of high- with TRD (p.2).
been maintained over
frequency and compared to
associated -this study found a six-month
theta-burst the sham
with that 80% of follow-up period
TMS on group (p. 462).
significant patients treated (p. 128).
suicidality in
Effectiveness of TMS in treatment-resistant depression 8

patients with - The trial improvements with TMS - The results

TRD. The found that left in depression showed a showed that

results showed prefrontal (p < 0.001), reduction in TMS was an

that both types TMS suicidality (p < depressive effective

of TMS were effectively 0.001), and symptoms after treatment for

effective in treats adult anhedonia (p < ten weeks of TRD, as the

reducing TRD (p. 462). 0.001) ( p. treatment ( p.3). TMS treatment

depression in 466). was associated

- The authors -The study also
these patients, with a decrease
concluded that - Hamilton found that in
with theta- in symptoms
TMS is a safe Rating Scale other patients,
burst TMS such as
and productive for Depression after 12 weeks of
having a more depression and
treatment for and Clinical treatment, 66%
significant anxiety (p. 128).
adolescents Global of the patients
effect than
with TRD (p. Impression with TRD had a - The study also
high-frequency
469). scores were significant found that the
TMS.
significantly reduction in their effects of TMS

-Furthermore, reduced with symptoms (p.3). were maintained

the authors TMS (p. 466). over a twelve-

-In addition,
concluded that month follow-up
TMS effectively
TMS is a period (p. 128).
reduces
promising
depressive
treatment
symptoms in
option for
 Effectiveness of TMS in treatment-resistant depression 9

TRD patients. patients who

(p. 534). have failed to

respond to

multiple other

treatments (p.3).

Main Idea B -TMS is an - The study - TMS can -In this study, - TMS was

effective found that the potentially TMS effectively associated with

TMS reduces
treatment for overall reduce reduced suicidal decreased
suicidality.
reducing reduction in depressive thoughts and suicidality in

suicidality in suicidal symptoms, behaviors in TRD patients

patients with ideation was suicidality, and patients with who had

TRD. significantly anhedonia in TRD (p.2). responded to an

more adolescents acute TMS

-The results of -Also, the
significant in with TRD (p. treatment in the
this study research found
the TMS group 462). research (p.
showed that that TMS
than in the 128).
both types of - TMS is significantly
sham group (p.
TMS associated reduced the - The study
465).
effectively with severity of results showed a

reduce - The authors significant suicidal ideation reduction in

suicidality in also noted a improvements in patients with suicidality due to

TRD patients, significant in Hamilton TRD as it TMS treatment

Effectiveness of TMS in treatment-resistant depression

10

with theta- reduction in Rating Scale affected the compared to the

burst TMS suicidal and Clinical brain's frontal control group.

having a more ideation Global lobe ( p.2).

significant among those in Impression

-Overall, the
effect than the TMS group scores (p.
evidence
high-frequency who had 466).
suggests that
TMS (p. 534). suicidal
TMS effectively
ideation at
-Specifically, reduces
baseline (p.
theta-burst suicidality in
465).
TMS was patients with

more effective - The authors TRD.

in reducing concluded that

suicidal TMS was

ideation and associated

behavior than with a

high-frequency reduction in

TMS (p. 535). suicidality as

its effects

significantly

impacted how

the patients

thought and
 Effectiveness of TMS in treatment-resistant depression

11

viewed things

(p. 465).

- TMS group - Adults with -Research has - in the study,

had higher Treatment- shown that there neurostructural

Neurostructural -From the
gray matter Resistant are differences were
differences. research, there
volume in the Depression neurostructural observed
are
right thalamus, (TRD) have differences between patients
neurostructural
right significantly between adults who responded
differences in
hippocampus, lower gray with TRD and to an acute TMS
TRD patients,
and right matter volume healthy ones treatment and
which may
caudate in the left (p.4) those who did
contribute to
nucleus hippocampus, not respond (p.
their condition. -Neuroimaging
compared to left amygdala, 128).
studies have
-The authors
the sham and right
found altered - The study
conducted a
group at insula
cortical thickness identified that
study
baseline (p. compared to
and reduced patients who
comparing
467). healthy
connectivity in responded to an
high-frequency
controls (p.
- The authors the prefrontal acute TMS
and theta-burst
463).
also found that cortex in patients treatment had
TMS effects
TMS was - Transcranial with TRD increased gray
on suicidality
associated Magnetic matter volume in
in TRD -Studies have
Effectiveness of TMS in treatment-resistant depression

12

patients. with increased Stimulation also found areas of the brain

gray matter (TMS) is reduced volumes associated with

- The results
volume in the associated in several brain emotion and
showed that
right thalamus with regions, such as motivation.
both types of
and significant the hippocampus
TMS - The study's
hippocampus increases in and amygdala, in
effectively results suggest
compared to gray matter patients with
reduced that TMS may be
the sham volume in TRD p.4).
suicidality in effective in
group (p. 467). these regions,
TRD patients. -These findings treating TRD
p. 468).
The authors - The authors suggest that due to its ability

hypothesized concluded that - There is an there may be to induce

that this might TMS might be association specific neurostructural

be due to the associated between the structural changes in the

modulation of with neurostructural differences in the brain (p. 128).

neurostructural neurostructural differences in brains of adults

differences in changes in the adults with with TRD that

patients with brain that may TRD and the TMS could

TRD (p. 535). contribute to efficacy of target.

the therapeutic TMS in

effects of TMS treating

(p. 467). disordered

neuro
Effectiveness of TMS in treatment-resistant depression

13

structures due

to depression

and its

associations.