CIRCADIAN HEART RATE AS A PROXY FOR TREATMENT RESPONSE OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) IN MAJOR DEPRESSIVE DISORDER: A PILOT STUDY

Background: Obsessive-compulsive disorder (OCD) and major depressive disorder (MDD) are highly comorbid, but literature about treatment (Tx) response to sequential transcranial magnetic stimulation (TMS) is limited.Hence, we conducted this case series.Methods: We identified ten cases with OCD and comorbid MDD.One was removed from analysis due to stopping TMS after two sessions.Patients received FDA approved protocols of theta-burst (TB) TMS for MDD and TMS for OCD sequentially.The outcome measures were a >30% reduction in Yale-Brown Obsessive-Compulsive Scale (YBOCS) for OCD and >50% reduction in Patient Health Questionnaire-9 (PHQ-9) scores for MDD in pre-and post-TMS evaluations and being assessed as "much" or "very much" improved in Clinical Global Impression-Improvement Scale (CGI-IS).Results: Data from 9 patients (mean age= 35.3, 89% (8/9) male, 67% (6/9) white) were analyzed.CGI-IS and pre-and post-Tx YBOCS and PHQ-9 scores showed significant improvement in 67% (6/9), 60% (3/5), and 67% (6/9) of cases, respectively.YBOCS were missing in 4 patients.Based on CGI-S five, three, and one patient were assessed markedly, severely, and among the most extremely ill.Conclusions: This study is limited by multiple factors due to open-label, retrospective nature, and small number of patients.Nevertheless, the findings are important as sequential TMS Tx was well tolerated and resulted in significant improvement in both OCD and MDD symptoms in this group.There is a need for randomized, larger, and controlled studies to investigate sequential TMS Tx further on this patient population.