Repetitive transcranial magnetic stimulation (rTMS) for comorbid major depressive disorder and hoarding disorder: An open label pilot study

BACKGROUND: Hoarding Disorder (HD) is characterized by persistent difficulty discarding possessions due to a strong urge to save them, resulting in excessive clutter that compromises functioning. Despite the common prevalence and profound consequences of HD, there are no FDA approved treatments. Individuals with HD often have comorbid major depressive disorder (MDD). This study examined the feasibility and initial efficacy of repetitive transcranial magnetic stimulation (rTMS) for HD patients with comorbid MDD. METHODS: Participants with moderate or severe MDD and co-morbid HD underwent daily neuronavigated intermittent theta burst stimulation (iTBS) rTMS to the left dorsolateral prefrontal cortex for 20 sessions over four weeks. Assessments of symptoms and neuropsychological performance were collected at pre-treatment, post-treatment, and 1-month follow up. RESULTS: Eleven individuals enrolled in the study (6 women; mean age 52). One participant dropped out after six sessions. Following iTBS treatment, depression symptoms on the Hamilton Depression Rating Scale-17 were reduced by 43% at post-treatment and 48% at follow-up. Hoarding symptoms on the Hoarding Rating Scale were reduced by 28% at post-treatment and 29% at follow-up, with the greatest reductions in difficulty discarding. Neuropsychological performance improvements were seen in attention/working memory, visual scanning, processing speed, and verbal learning (p < 0.05). CONCLUSIONS: This is the first clinical trial of rTMS for MDD + HD and demonstrates preliminary feasibility and clinical improvement and the potential role for rTMS in HD treatment. Using rTMS to treat MDD in individuals with HD may open new avenues of care for this severe and undertreated disorder.