Depression is often recurrent, so a natural question after a successful course of TMS is how to keep the benefit. The honest answer is that maintenance TMS is promising and widely used, but the controlled evidence for the best schedule is still developing.
The benefit is reasonably durable
For many patients the improvement from an acute course holds up well. In a large multisite naturalistic study, the gains seen at the end of treatment were largely sustained across a year of follow-up, with most acute responders staying well over that period.
Relapses tend to respond
When symptoms do return, re-treatment usually works. In follow-up cohorts, the large majority of patients who relapsed regained benefit with another course of TMS.
How much maintenance?
The controlled evidence on scheduled maintenance is mixed. A randomised pilot found that a single once-a-month session was not clearly better than no maintenance, suggesting that is too little. More intensive clustered maintenance, such as a short run of sessions each month, has delayed relapse in open-label work, but that evidence is not yet sham-controlled.
Acute TMS benefits often last many months, relapses usually respond to re-treatment, and maintenance TMS is widely practised, but the optimal schedule is not yet settled and a single monthly session appears insufficient.
References
- Dunner DL, et al. (2014). A multisite, naturalistic, observational study of TMS: durability of benefit over a 1-year follow-up.
Journal of Clinical Psychiatry. - Philip NS, et al. (2016). Predictors of response and durability; randomized maintenance data.
This article is for general information and is not medical advice. TMS suitability is decided by a psychiatrist on an individual basis. Speak to our team about your own situation.