Deep TMS and SSRIs for Treatment Resistant Depression

Alternate Day Deep TMS Combined with SSRIs for Chronic Treatment Resistant Depression: A Prospective Multicenter Study

Journal: Journal of Affective Disorders 240:130-136 (2018)

Authors: A Tendler, R Gersner, Y Roth, A Zangen


Chronic treatment resistant depression takes a substantial toll on patients’ quality of life and alternative treatment options are limited.


This prospective multicenter study evaluated the safety, tolerability and efficacy of four weeks of thrice-a-week deep transcranial magnetic stimulation (Deep TMS™) in combination with selective serotonin reuptake inhibitors (SSRIs).


Forty patients who failed to respond during a 16-week double-blind placebo controlled (DBPC) trial of Deep TMS or sham Deep TMS as monotherapy were screened and started a treatment of previously tolerable but ineffective SSRI. After ten days of medication, high frequency Deep TMS was added three times a week for four weeks.


Deep TMS combined with SSRIs was well tolerated, with only headaches as a related adverse event (n = 4), which did not cause drop outs. Six patients were excluded from analysis: 1 was missing screening data and 5 received less than 10 sessions. Out of 34 patients included in this study, 12 (35.3%) patients remitted (HDRS-21 < 10). No significant differences were found between patients who had received sham or active Deep TMS in the earlier DBPC multicenter trial.


Thrice weekly Deep TMS at 120% motor threshold(MT), 10 HZ, 3 s trains, 20 s intervals, 2400 daily pulses, can augment formerly ineffective SSRI treatment.

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