DOI: 10.4103/jnsm.jnsm_238_25 ISSN: 2589-627X

Clinical Response to Repetitive Transcranial Magnetic Stimulation in Treatment-resistant Depression: A Prospective Multicenter Study

Hajar Al-Saidi, Tamadhir Al-Mahrouqi, Muna Al-Balushi, Badriya Al-Ghammari, Sathiya Panchatcharam, Said Al-Kaabi
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Abstract

Objectives:

This study aimed to evaluate treatment response and remission rates following repetitive transcranial magnetic stimulation (rTMS) and to assess changes in depression severity. It also examined sociodemographic, clinical, and treatment-related predictors of rTMS outcomes in patients with treatment-resistant depression (TRD) in the Omani population.

Methods:

This prospective observational study included 64 patients diagnosed with TRD who received at least 20 sessions of rTMS between March 2023 and March 2025 at Almassara Hospital and Al Seeb Polyclinic. Treatment response and remission were assessed using the Clinical Global Impression-Improvement and Severity (CGI-S) Scale. Bivariate analyses were conducted using Chi-squared tests for categorical variables and independent-samples t -tests for continuous variables to identify potential predictors of response and remission, with statistical significance set at P < 0.05. Variables of interest were subsequently entered into binary logistic regression models to identify independent sociodemographic, clinical, and treatment-related predictors of response and remission.

Results:

The mean duration of illness was 8.9 years (standard deviation = 6.9), with a mean of 2.8 failed antidepressant trials. Participants received a mean of 27.1 rTMS sessions at an average stimulation intensity of 58.7% of resting motor threshold. The overall response rate was 53.1%, and the remission rate was 40.6%. Mean CGI-S scores improved from 5.2 at baseline to 3.7 post-treatment. Benzodiazepine use was significantly associated with a lower likelihood of treatment response ( P = 0.006). In logistic regression analyses, increasing age was independently associated with a higher likelihood of remission (odds ratio [OR] = 1.166, 95% confidence interval [CI]: 1.047–1.300, P = 0.005), benzodiazepine use was associated with reduced odds of remission (OR = 0.053, 95% CI: 0.007–0.433, P = 0.006). Higher baseline depression severity was associated with lower remission rates.

Conclusions:

rTMS was associated with clinically meaningful response and remission rates in patients with TRD in Oman. Older age emerged as an independent predictor of remission. Benzodiazepine use was associated with reduced treatment response, whereas its relationship with remission warrants cautious interpretation. These findings underscore the importance of careful patient selection and medication review when considering rTMS for TRD.

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