Home-based TMS treatment of depression using accelerated intermittent theta-burst stimulation (aiTBS): a pioneering feasibility study

Introduction: Transcranial magnetic stimulation (TMS) is an evidence-based treatment option for major depressive disorder (MDD), but to date it is offered exclusively in hospitals or doctors' offices. Methods We conducted a pilot study, to investigate the feasibility of home-based TMS treatment (mTMS) for patients suffering from MDD. Five MDD outpatients (29–65 years) living in a distance of up to 120km from our tertiary care hospital (Regensburg, Germany) were treated with an accelerated intermittent theta burst protocol (aiTBS: 5 treatments per day, 1800 pulses per session) using a DuoMAG XT-100 device (Deymed Diagnostics, Hronov, Czech Republic). Clinical results were compared with five patients matched for age, gender and baseline questionnaire scores, who were treated with the same aiTBS protocol, but in our clinic with a MagPro X100 (MagVenture Inc., USA). In both settings, depressive symptoms were assessed with the 21-item Hamilton Depression Rating Scale (HAMD-21) and the Major Depression Inventory (MDI) before and after the respective treatment. Results Home-based TMS was feasible and no serious side effects occurred. In both settings, TMS treatment resulted in a reduction of the HAMD-21 and MDI scores. Conclusion Our pilot data suggest that home-based TMS treatment is feasible. Further investigations in larger samples are warranted. Home-based treatment with large TMS-devices that are designed for use in clinics has major logistical disadvantages (e.g. difficult transportation), indicating the need for the development of more portable devices. Home-based administration of TMS should be further developed as it might extend the range of potential application.