Transcranial Magnetic Stimulation in Veterans - Real World Efficacy and the Foundation for Mechanistic Insights

Abstract

Background: PTSD is a severe and disabling disorder that is often comorbid with major depression Despite this common comorbidity, traditional studies of transcranial magnetic stimulation (TMS) often excluded these individuals, and other treatment options have modest efficacy or are limited by side effects This session will review large-scale, unpublished naturalistic data describing the use of TMS in US Veterans and place these findings alongside functional neuroimaging and EEG mechanisms of TMS To this end, the VA is engaged in a multi-site TMS dissemination project that included monitoring outcomes with a database of demographic information and clinical rating scales Methods: Outcomes were assessed from 2017 to March 2020 (i e , pre-COVID19) Depression symptoms were measured using the 9-item patient health questionnaire (PHQ9) and PTSD symptom checklist for DSM5 (PCL-5) Outcomes of interest included symptom changes, dichotomous outcomes, and safety Results: 413 Veterans with MDD were included, and of these, two thirds (n=275) had PTSD After TMS, there was statistically significant and clinically meaningful reduction in MDD and PTSD (all p<0 01) MDD response and remission rates were 46 2% (n=191) and 23 7% (n=98), respectively Of veterans with PTSD, n=159 (57 5%) demonstrated clinically meaningful reduction and n=130 (47 2%) no longer met threshold criteria after TMS Side effects were generally benign and consistent with the known safety profile of TMS Conclusions: This multisite naturalistic data indicates the effectiveness of TMS for MDD and PTSD Limitations include those inherent to naturalistic cohort studies Future reports using this VA network will evaluate the impact of different TMS parameters and biomarkers of response Supported By: VA RR&D Center for Neurorestoration and Neurotechnology;VA Grants HSR&D, I01 HX002572, CSR&D I01 CX002088 and NIMH R01 MH120126 Keywords: Repetitive Transcranial Magnetic Stimulation (rTMS), MDD, PTSD, US Veterans