Case Report: Personalizing Transcranial Magnetic Stimulation Therapy for Treatment-Resistant Depression for a Patient with Complex Medical History.

Patients presenting with treatment-resistant depression (TRD) often have complex medical comorbidities that can limit the use of new and novel treatments. Transcranial magnetic stimulation (TMS) is FDA-approved and, overall, has a low adverse side-effect profile. Consensus guidelines, however, are broad and lack specificity around managing individual patient risk. Therefore, individual clinicians must make significant determinations about candidacy and risk management in medically complex patient presentations. This case report details a 49-year-old male with a 10-year history of major depressive disorder with significant medical comorbidity (chronic pain, post-thyroidectomy hypocalcemia secondary to hypoparathyroidism, and basal ganglia calcifications). We illustrate how interdisciplinary care coordination can allow for safe and effective use of TMS in a medically complex patient with severe TRD. This case highlights the importance of personalized treatment planning to expand access to neuromodulation.