High Frequency Left-Sided Repetitive Transcranial Magnetic Stimulation (rTMS) for Post Traumatic Stress Disorder With Comorbid Major Depressive Disorder

ObjectiveRepetitive transcranial magnetic stimulation (rTMS) is an established treatment for comorbid post-traumatic stress disorder (PTSD) and major depressive disorder (MDD). However, there are no universal protocols regarding the type of rTMS recommended, including among military and first responders. This study aimed to describe high frequency rTMS applied to the left dorsolateral prefrontal cortex (DLPFC) administered to inpatients with comorbid PTSD and MDD at Ward 17, Austin Health in Melbourne, Australia.MethodRetrospective review of patient files was undertaken for adult inpatients admitted between 01/01/2017 and 01/12/2024 with PTSD and MDD who received ten or more rTMS treatments during admission. Paired t-tests were used for statistical analysis.ResultsAmong 65 patients and 118 admissions, the majority received high frequency rTMS to the left DLPFC (n = 106, 89.8%), followed by rTMS applied to the right DLPFC (n = 8, 6.8%). The group who received left-sided rTMS had an average of 6 fewer treatments and admission length that was 10 days shorter, but almost half required readmission for further rTMS treatments. The most common side effects reported were pain, fatigue, light-headedness or dizziness, and increased anxiety. Left-sided rTMS was associated with significant improvements in MADRS (Cohen's D = 1.36, 95% CI = 1.06-1.65, <i>P</i> < .001), PCL-5 (D = 1.18, 95% CI = 0.72-1.63, <i>P</i> < .001), HoNOS (D = 1.20, 95% CI = 0.94-1.46, <i>P</i> < .001), and MoCA scores (D = -0.56, 95% CI = -0.81 to -0.31, <i>P</i> < .001).ConclusionsHigh frequency left-sided rTMS is generally well tolerated and may reduce both depressive and PTSD symptoms. Further research to assess rTMS subtypes and target specific symptomatology would support standardization of care and inform future protocol guidelines.