Journal: Brain Stimulation (2025)
Authors: N Philip, F Kozel, E Walter, E McMillan, B Wicklund, Z Zuschlag, M Madore
Background:
TMS holds promise for posttraumatic stress disorder (PTSD); while recent randomized controlled trials have provided mixed evidence (e.g., [4–6]), large-scale effectiveness data strongly supports the use of standard TMS for those who have PTSD comorbid with MDD.
Objective:
This study examined the first cohort of patients to receive off-label accelerated TMS with the Veterans Affairs (VA) Clinical TMS program, hypothesizing that accelerated TMS would be efficacious for PTSD symptom improvement. We also explored depression outcomes in Veterans without comorbid PTSD to provide an additional estimate of efficaciousness.
Methods:
The protocol used was left DLPFC targeting at 100 % of motor threshold, intermittent theta burst stimulation (iTBS) of 1800 pulses five times a day with a 50-min intersession interval, for five business days; total number of iTBS pulses was 45,000. A total of n = 123 Veterans with PTSD across 15 sites received the accelerated TMS protocol that includes the nineteen previously reported [8]; 96 (78 %) completed the five-day protocol and had complete data. Demographics were consistent with Veteran samples; average age (standard deviation; SD) was 48 (12.6) years, majority (72 %) white, 13.8 % Hispanic, and 20 % female.
Results:
This pragmatic accelerated TMS protocol yielded a robust completion rate alongside statistically significant and clinically meaningful reductions in PTSD symptoms. Notably, this accelerated protocol achieved in 5 days what first-generationly takes 6 weeks, representing a major advance in treatment efficiency; the magnitude of symptom reduction (∼20 points) and PTSD response and remission rates are at least comparable to standard TMS. While depressive symptom improvement was meaningful (8–10 points), clinical response and remission rates for depression were more modest in those with comorbid PTSD and MDD; in the group without PTSD, outcomes were improved overall with an average posttreatment score nearing remission.
Conclusions:
This report describes large and robust improvements in PTSD symptoms in a short period of time using a highly scalable TMS protocol, underscoring the potential for accelerated TMS to dramatically reduce treatment duration while maintaining efficacy, potentially improving access to care.
