title: Maintenance transcranial magnetic stimulation reduces depression relapse: a propensity-adjusted analysis.
abstract: BACKGROUND
  The effectiveness of repetitive transcranial magnetic stimulation (TMS) is well established while studies of maintenance TMS are lacking. We aim here to determine whether maintenance is associated to a decrease in the relapse rate of depression, following successful acute treatment.
  
  
  METHODS
  We enrolled 59 consecutive patients with pharmacoresistant depression who have responded (>50% decrease in symptom severity) up to 6 weeks of acute TMS treatment. These patients received either 20 weeks of maintenance TMS (n=37) or no additional TMS treatment (n=22). We performed propensity adjusted-analysis to examine the association between the relapse rate over this 20-week period and maintenance TMS. Propensity analysis eliminated differences in baseline characteristics between patient with and without maintenance TMS and approximated the conditions of random site-of-treatment assignment.
  
  
  RESULTS
  At 20 weeks, relapse rate was significantly different between the two groups (p=0.004, propensity analysis): 14 patients in the maintenance TMS group (37.8%) vs. 18 in the non-maintenance TMS group (81.8%), with an adjusted Hazard Ratio (HR)=0.288 (0.124-0.669).
  
  
  CONCLUSIONS
  Maintenance TMS was associated with a significantly lower relapse rate in patients with pharmacoresistant depression in routine practice among responders.
authors.affiliation: Department of Psychiatry, Sainte-Marguerite University Hospital, 13009 Marseille, France. raphaellemarie.richieri@ap-hm.fr
authors.forename: Raphaëlle
authors.initials: R
authors.lastname: Richieri
authors.forename: Eric
authors.initials: E
authors.lastname: Guedj
authors.forename: Pierre
authors.initials: P
authors.lastname: Michel
authors.forename: Anderson
authors.initials: A
authors.lastname: Loundou
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.forename: Christophe
authors.initials: C
authors.lastname: Lançon
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
mesh_terms: D003865:Major Depressive Disorder / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D055502:Secondary Prevention; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D016896:Treatment Outcome
keywords: Depression; Maintenance treatment; Repetitive transcranial magnetic stimulation