Treatment outcomes in depression – TMS vs. Psychiatric treatment as usual

At Smart TMS we are always striving to improve our patients’ outcomes. We consult the latest research and implement it into our service. At the latest TMS research conference, the CTMSS conference, we discovered a study comparing treatment with medication to TMS. Here we share the summary. 

Remission in Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD), also known as depression, is a worldwide leading cause of disability. Despite extensive research into pharmaceutical treatments, patients suffering from MDD do not achieve remission after first line antidepressant treatment. In addition to that, the chances of remission decrease with each subsequent medication trial. 

TMS for treatment resistant depression 

Transcranial Magnetic Stimulation (TMS) is an effective treatment for MDD and has proven efficacy in treatment resistant subjects. However there is a lack of psychiatric understanding of when it is optimal to introduce TMS treatment in MDD patients. The objective of this study is to evaluate TMS utilisation in a cohort of 1002 patients and compare patient treatment outcomes between TMS and treatment as usual.  

Study findings – TMS is more effective in patients with higher treatment resistance 

89 of the 1002 patients considered in the study had been treated with TMS. The TMS patients had, on average, a higher level of treatment resistance reflected in the number of failed antidepressant trials, as well as a higher clinical depression score (baseline PHQ-9). The results show that treatment with TMS led to a significantly higher reduction in depression symptoms at 6 months. Moreover, in patients with higher treatment resistance (over 4 failed medication trials), TMS was almost 2 times more effective than treatment as usual in terms of reduction in PHQ-9 score. The response rate was also significantly higher in patients with higher treatment resistance, as it can be seen in the graph below, taken from the original study.(Bastiaens et al.,2022) 

TMS vs Psychiatric treatment as usual Conclusions 

This study has shown that TMS in combination with treatment as usual, had better outcomes for treatment resistant depression than just treatment as usual alone. Despite the fact that patients who received TMS had more severe depression. The benefits of TMS were also more notable when comparing patients with similar treatment resistance levels, with the effects being sustained 6 months after treatment. 


Despite the fact TMS provides better outcomes for patient with high level of treatment resistance, only 10% of the cohort received TMS. This emphasises the need for more research into the hesitancy to utilise TMS and the need for a consensus on when to introduce TMS. Prescribing TMS at an earlier stage in treatment has the potential to make a dramatic difference in patient remission for those with treatment-resistant depression. More research is needed on this subject. 

Author, Roxy Ioan,
Smart TMS Hampshire Practitioner


Bastiaens, J., Brown, N., and Bermudes, R.A., (2022). Mindful Health Solutions, Innovative Psychiatry Services. Utilization and Outcomes of Treatment as Usual and Transcranial Magnetic Stimulation in a Large Group Psychiatric Practice.