Antipsychotic co-medication and treatment response to rTMS and iTBS in depression: Data from clinical records from two independent clinical sites.

RATIONALE: Transcranial magnetic stimulation (TMS) is a well-established, noninvasive method for modulating cortical activity and has demonstrated efficacy in the treatment of depression. This study investigated potential interaction effects between antipsychotic augmentation and TMS efficacy using clinical records from two independent sites. In addition, exploratory analyses examined the association between resting motor threshold (RMT) and treatment outcomes.

METHODS

We analyzed naturalistic data from patients with depressive symptoms treated at the TMS outpatient departments in Augsburg (n = 53) and Regensburg (n = 120). Depressive symptom severity was assessed using the Beck Depression Inventory, Hamilton Rating Scale for Depression-17, and Major Depression Inventory at baseline, during treatment, and upon treatment completion. Patients were grouped according to whether or not they received antipsychotic augmentation. Group comparisons were conducted using Mann-Whitney U tests. For secondary analyses, scatter plots explored associations between baseline RMT and improvements in depressive symptoms, and correlation coefficients were calculated.

RESULTS

At the Augsburg site, 2 weeks after treatment initiation, patients not receiving antipsychotic augmentation exhibited significantly greater improvement in depressive symptom severity. However, differences between groups were not significant at treatment initiation or upon completion. Further, RMT analysis at Augsburg indicated a numerical but nonsignificant correlation with treatment outcome. At the Regensburg site, no consistent interaction effects were observed, and RMT analyses revealed nonsignificant correlations.

CONCLUSIONS

Taken together, these findings suggest that TMS can remain effective in patients receiving concomitant antipsychotic augmentation alongside antidepressant and TMS treatment. Future research could usefully examine whether TMS remains effective in patients receiving different kinds of antipsychotic medication.