Hello, I'm Christina Ed, a fourth-year osteopathic medical student at Pacific Northwest University of Health Sciences. And my name is Maggie, I'm also a fourth-year osteopathic medical student at PNWU. And the title of our project is Pulses of Potential, Assessing the Efficacy of Transcranial Magnetic Stimulation Across Age Groups. So major depressive disorder and generalized anxiety disorder are two of the most common mental health conditions encountered in primary care, affecting individuals of all ages. Transcranial magnetic stimulation has consistently demonstrated safety and efficacy in various meta-analyses as an adjunct to pharmacotherapy in adults, particularly for treatment-resistant depression and its potential application in generalized anxiety disorder. This non-invasive procedure uses magnetic fields to target the dorsolateral prefrontal cortex in the brain to improve symptoms of various mental health conditions. However, in many cases, TMS is not considered an option unless the patient has failed multiple trials of medications and psychotherapy. Although the FDA-approved neuromodulation technique has been used for over a decade, it is still not widely known among patients and healthcare professionals. Furthermore, studies of TMS efficacy in special populations, such as geriatrics in children and adolescents, have been inconclusive. So our objective is to assess the efficacy of TMS on treatment-resistant depression and anxiety across different age demographics, aiming to uncover whether certain age populations exhibit a more favorable response. So our methods, the design of the study involved a retrospective data analysis using data-maintained in the electronic health record at Olympia Center for TMS and Psychiatry. 288 patients with treatment-resistant depression who completed 36 standard repetitive TMS or theta burst stimulation treatments between 2020 and 2023 were selected. Patients' scores from the Patient Health Questionnaire 9, also known as PHQ-9, and Generalized Anxiety Disorder 7, also known as J87, were used to assess the severity of their depression and anxiety before and after treatments. Among the 288 patients, 204 had initial J87 scores greater than or equal to 10, indicating coexisting moderate to severe anxiety. The patients were then categorized into three age groups, pediatrics, consisting of patients 21 years and older and young, old and younger, adults between 22 and 64 years old, and geriatrics, those 65 years old and greater. Treatment efficacy was measured by averaging the initial and final PHQ-9 or J87 scores and conducting a paired t-test for all age groups and each age population. In a clinical setting, treatment response was defined as 50% reduction in PHQ-9 or J87 scores. The percentage of all subjects and each population that responded to treatment was calculated, and a chi-square analysis was performed on age groups. Here are our results. Out of 288 patients with treatment-resistant depression as seen in Table 1, 39 were pediatrics, 192 were adults, and 57 were geriatrics. Figure 1 shows that after treatment with TMS, 74% of the total participants demonstrated a 50% improvement in PHQ-9 scores. The response rates by age groups were 51% for pediatrics, 77% for adults, and 81% for geriatrics. A chi-square test among these groups yielded a p-value of 0.002, indicating a significant difference in response rates across age groups. Figure 2 refers to the efficacy of TMS for treatment-resistant depression as indicated by the improvement in mean PHQ-9 scores. There were significant overall and within each age group, with p-values less than 0.001. In Table 2, of the 204 patients with coexisting moderate to severe anxiety, 26 were pediatrics, 151 were adults, and 27 were geriatric patients. Following TMS treatment, 54% of all participants showed a 50% improvement in GAD-7 scores as seen in Figure 3. The response rates were 31% for pediatrics, 58% for adults, and 56% for geriatrics. A chi-square test among these age groups showed a p-value of 0.03, indicating a significant difference in anxiety improvement across age groups. Figure 4 shows the efficacy of TMS for generalized anxiety disorder as indicated by the improvement in average GAD-7 scores. There were significant overall and within each age group, with p-values less than 0.001. Our conclusion shows that TMS exhibits promising response rates and efficacy in addressing depression and anxiety symptoms. Data analysis reveals significant improvements in symptom severity across various age groups, suggesting the potential integration of TMS alongside pharmacotherapy for managing major depressive disorder and generalized anxiety disorder. The result is notable given the adverse effects associated with pharmacotherapy, specifically increased suicide risk with SSRI use in adolescents and concerns regarding polypharmacy among geriatric patients. Our results support TMS as a viable alternative, potentially even as a stand-alone treatment option. The limitations in our study include the absence of sham groups for comparison and relatively small sample sizes for certain age groups, which warrant consideration. To increase TMS utilization, future investigations should delve into barriers to successful treatment outcomes, including factors contributing to low TMS treatment adherence, such as frequency of daily sessions, insurance coverage limitations, and geographical accessibility. Understanding these barriers and how they impact treatment outcomes can help inform efforts to enhance the application and accessibility of TMS therapy. We thank you for your time and please let us know if you have any questions.

Transcranial Magnetic Stimulation

treatment-resistant depression

anxiety

efficacy study

PNWU