Concurrent Pharmacotherapy With SNRIs: Does it Enhance TMS Efficacy in Depression?

Background:The "One-Day" TMS protocol (ONE-D) condenses treatment for MDD and GAD into a single day, delivering 20 highfrequency iTBS sessions (600 pulses, 120% motor threshold) over 9.5 hours.This retrospective case series of 8 patients (August-December 2024) used off-label d-cycloserine (125 mg) and lisdexamfetamine (20 mg) to enhance neuroplasticity.Conducted in a primary care setting, the study demonstrates the feasibility of advanced TMS protocols outside specialized facilities.Methods: This retrospective case series evaluated 8 patients treated with ONE-D between August and December 2024, assessing PHQ-9 and GAD-7 scores pre-treatment and up to 16 weeks posttreatment.Results: Average PHQ-9 scores decreased from 16.7 6.8 to 10.4 7.6, reflecting a mean reduction of 42.1%.Average GAD-7 scores decreased from 13.6 5.3 to 7.0 5.2, a mean reduction of 59.9%.The protocol achieved a response rate of 62.5% (50% reduction in either PHQ-9 or GAD-7) and a remission rate of 37.5% (PHQ-9 < 5 and GAD-7 < 5).No adverse events.Well-tolerated.Discussion: The accelerated ONE-D TMS protocol shows potential in managing major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a primary care setting.Symptom reductions of 42.1% for PHQ-9 and 59.9% for GAD-7, with a 62.5% response rate and 37.5% remission rate, highlight its efficacy.Patient 1 (PHQ-9: 23 2; GAD-7: 18 1) and Patient 8 (PHQ-9: 23 3; GAD-7: 18 1) demonstrate its ability to achieve remission.