Synergistic use of deep TMS therapy with IV ketamine infusions for major depressive disorder: a pilot study.

Major Depressive Disorder affects about 21 million U.S. adults, and 30-60% do not respond to standard treatments. Two promising options are transcranial magnetic stimulation (TMS) and ketamine infusions, but they have rarely been studied together. In a non-randomized study, 169 participants with treatment-resistant depression received 36 sessions of Deep TMS alone, while 66 received the same TMS plus six intravenous ketamine infusions over nine weeks. Depressive symptoms, measured by the PHQ-9, decreased significantly in both groups from before to after treatment. The TMS-plus-ketamine group showed an 80.30% response rate and 43.42% remission rate, compared to 76.92% response and 39.64% remission with TMS alone. These differences were not statistically significant, indicating no added benefit from adding six ketamine sessions to TMS.

Study at a glance

Abstract

Major Depressive Disorder (MDD) is a pervasive psychiatric condition effecting approximately 21 million adults in the U.S. (8.4%). An estimated 30-60% of patients are resistant to traditional treatment approaches (medications and talk-therapy), alluding to the need for additional options. Two promising treatment modalities include transcranial magnetic stimulation (TMS) and ketamine infusions; both have shown efficacy in standalone studies but have scarcely been investigated synergistically in the same group of participants. In the current study, 169 participants with treatment-resistant MDD received 36 treatments of Deep TMS-only (H1 + H7 protocols), while 66 received 36 treatments of Deep TMS (H1 + H7 protocols) and 6 IV infusions of ketamine over the course of 9 weeks. Depressive symptoms were compared pre- and -post treatment in both conditions using the PHQ-9. In both treatment groups, depressive symptoms were significantly reduced from pre-to-post and there were no significant differences in response between the TMS + ketamine condition and the TMS-only condition. The TMS + ketamine condition had an 80.30% response rate (53 out of 66) and 43.42% remission rate (28 out of 66) compared to a 76.92% response (130 out of 169) and 39.64% remission (67 out of 16) in the TMS-only condition. These results support the notion that TMS treatments yield high response rates in treatment-resistant cases; however, in this investigation there was no added benefit for including 6 sessions of IV ketamine in conjunction with TMS. Future investigations using randomized-control designs and robust outcome measures are warranted.