Quantitative EEG (qEEG) Guided Transcranial Magnetic Stimulation (TMS) Treatment for Depression and Anxiety Disorders: An Open, Observational Cohort Study of 210 Patients

SOURCE: Journal of Affective Disorders. 308:322-327, 2022 Jul 01.

AUTHORS: Robertson C; Mortimer A

BACKGROUND: Major depression and anxiety disorders represent a substantial burden of morbidity. Neither antidepressant medication nor psychological interventions are fully effective, the former beset with side effects, interactions and compliance issues, and the latter requiring patient engagement, effort and a degree of psychological mindedness. Both treatments are lengthy. TMS by contrast is virtually free of side effects and compliance issues, relatively brief, and requires no patient effort. Nevertheless, remission rates are only about 1 in 3 with standard left frontal rapid (rTMS) stimulation, and up to 30 treatment sessions may be required. Our aim was to improve the effectiveness of TMS treatment using bespoke as opposed to standard left frontal rTMS, including theta burst stimulation (TBS).

METHODS: 210 male and female patients were treated: regions and frequencies of TMS were guided by quantitative EEG analysis (qEEG) to elicit recognisable phenotypes, neuromarkers integral to the genesis of major depression and anxiety disorder, dictating treatment parameters.

RESULTS: 98 patients (47%) achieved at least 50% reduction in Hamilton depression rating scale scores, while a further 60 (29%) patients achieved a 30-50% reduction, over a mean of 7.03 +/- 0.3 treatment sessions. Theta burst stimulation (TBS) almost halved treatment time within session compared to rTMS. The effect size (Cohen’s d) for both treatments was large (>0.8) with rTMS at 1.43 (1.16-1.70) and TBS at 1.87 (1.48-2.25). 

CONCLUSIONS: qEEG guided TMS treatment is a safe and effective treatment in depression and anxiety disorders.