Repetitive transcranial magnetic stimulation (rTMS) has helped improve outcomes in most patients with treatment-resistant depression (TRD) treated within a local general hospital, according to retrospective study.
The Montgomery-Åsberg Depression Rating Scale (MADRS) score decreased significantly from 29.6 at baseline to 13.9 after a mean of 30 treatment sessions (p<0.001), representing a mean reduction of 55.8 percent, reported Drs Yi Hang Tay and Christabel Thng from Khoo Teck Puat Hospital (KTPH), Singapore. [Front Psychiatry 2026;17:1924135]
The MADRS response rate was 67.9 percent (95 percent confidence interval [CI], 49.3–82.1), and the remission rate was 57.1 percent (95 percent CI, 39.1–73.5).
Significant improvements were also seen for all secondary measures (p<0.001 for all), including the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16); the Depression, Anxiety and Stress Scale-21 (DASS-21); the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF); the Clinical Global Impression-Severity (CGI-S); and the Global Assessment of Functioning (GAF).
In exploratory analyses, shorter depressive episode duration and higher baseline quality of life emerged as significant predictors of remission.
“Treatment with rTMS was generally well-tolerated,” Tay and Thng noted.
The most common adverse events were headache (32.1 percent), scalp discomfort or pain (28.6 percent), and facial muscle twitching (14.3 percent). These events occurred mostly within the first week and were transient, mild, and resolved spontaneously or with simple analgesia without necessitating treatment discontinuation. There were no documented events of tinnitus, hearing impairment, syncope, or seizure.
“These findings contribute real-world data to the limited Southeast Asian literature on standardized rTMS protocols for TRD in general hospital and similar clinical settings,” Tay and Thng said.
“The only other published naturalistic rTMS outcomes from Southeast Asia come from Singapore’s tertiary psychiatric hospital, the Institute of Mental Health (IMH), which reported a response rate of 20.8 percent and remission rate of 17 percent,” they continued. [Ann Acad Med Singapore 2024;53:471-480]
Tay and Thng emphasized that response and remission rates vary across naturalistic studies due to differences in patient populations and treatment delivery. For instance, while baseline MADRS was similar between the KTPH cohort and the IMH cohort (29.6 vs 28.1), more patients in the KTPH cohort had failed three or more antidepressant medications (96.4 percent vs 66.2 percent. Furthermore, the KTPH cohort was treated as outpatients, whereas 40.9 percent of the IMH cohort were inpatients.
“Further research in Southeast Asians with TRD is important, as patient profiles in Southeast Asia differ not only from Western cohorts but also from other Asian populations, such as East Asians, in ways potentially relevant to treatment response and generalisability. These include distinct metabolic phenotypes and body composition, which are of interest given that metabolic markers such as BMI, insulin resistance, and lipid profile have themselves been directly implicated as predictors of rTMS response,” Tay and Thng said.
The present study included 28 KTPH outpatients with TRD who received rTMS (10Hz high-frequency or intermittent theta-burst) targeting the left dorsolateral prefrontal cortex. TRD was defined as inadequate response to ≥2 antidepressant classes for ≥6 weeks each.