Implementation of accelerated transcranial magnetic stimulation treatment for an individual with treatment-resistant depression: A case report

Major depressive disorder (MDD) is one of the most common mental disorders in the United States. Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of major depression. However, the frequency and duration of the treatment schedule make compliance difficult for many patients. Accelerated theta-burst transcranial magnetic stimulation (TBS-rTMS), which involves multiple sessions of TMS in a single day, has shown promise for improved clinical outcomes despite a shorter treatment duration. We present a case of a 24-year-old woman with MDD with treatment-resistant depression (TRD) who was treated with accelerated TBS-rTMS at an inpatient psychiatric facility. The patient underwent 46 treatments of TBS-TMS per day over 5 days at 110 % of motor threshold in addition to group and 1:1 therapy and medications. The patient showed improvement on the Montgomery-Åsberg Depression Rating Scale (MADRS), Patient Health Questionnaire-9 (PHQ-9), Becks Depression Inventory (BDI), and General Anxiety Disorder-7 (GAD-7) over the 5-day course of treatment. One year later, PHQ-9, BDI, and GAD-7 scores were sustained. This case suggests that TBS-rTMS be considered for cases of MDD with TRD that do not respond to other forms of therapy.