5 Hz Repetitive transcranial magnetic stimulation for posttraumatic stress disorder comorbid with major depressive disorder

Linda L. Carpenter, Christine Conelea, Audrey R. Tyrka, Emma S. Welch, Benjamin D. Greenberg, Lawrence H. Price, Matthew Niedzwiecki, Agustin G. Yip, Jennifer Barnes, Noah S. Philip

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Background: Standard clinical protocols for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) apply 10 Hz pulses over left prefrontal cortex, yet little is known about the effects of rTMS in more diagnostically complex depressed patients. Objective/hypothesis: Posttraumatic stress disorder (PTSD) is commonly comorbid with MDD, and while rTMS has been shown to alleviate PTSD symptoms in preliminary studies, ideal parameters remain unclear. We conducted a prospective, open-label study of 5 Hz rTMS for patients with comorbid PTSD + MDD and hypothesized stimulation would reduce symptoms of both disorders. Methods: Outpatients (N = 40) with PTSD + MDD and at least moderate global severity were enrolled. 5 Hz rTMS included up to 40 daily sessions followed by a 5-session taper. Symptoms were measured using the PTSD Checklist (PCL-5) and Inventory of Depressive Symptomatology, Self-Report (IDS-SR). Baseline-to-endpoint changes were analyzed. Results: The intent-to-treat population included 35 participants. Stimulation significantly reduced PTSD symptoms (PCL-5 baseline mean ± SD score 52.2 ± 13.1 versus endpoint 34.0 ± 21.6; p <.001); 23 patients (48.6%) met a pre-defined categorical PTSD response criteria. MDD symptoms also improved significantly (IDS-SR, baseline 47.8 ± 11.9 to endpoint 30.9 ± 18.9; p <.001); 15 patients (42.9%) demonstrated categorical response and 12 (34.3%) remitted. PTSD and MDD symptom change was highly correlated (r = 0.91, p <.001). Limitations: Unblinded single-arm study, with modest sample size. Conclusion: Significant and clinically meaningful reductions in both MDD and PTSD symptoms were observed following stimulation. The preliminary efficacy of 5 Hz rTMS for both symptom domains in patients with comorbid disorders supports future controlled studies.

Original languageEnglish (US)
Pages (from-to)414-420
Number of pages7
JournalJournal of Affective Disorders
StatePublished - Aug 1 2018

Bibliographical note

Funding Information:
This study was funded in part by an investigator-initiated grant from Neuronetics, Inc. to Butler Hospital (Drs. Carpenter and Philip). Drs. Carpenter, Tyrka and Price have received grant support from Janssen , Neosync , and Cervel Neurotech through clinical trials contracts with Butler Hospital. Neosync and Neuronetics have provided devices for research underway by several coauthors. Dr. Carpenter has received consulting income from Magstim Ltd. Dr. Philip has served as an unpaid scientific advisory board member for Neuronetics. All other authors report no biomedical financial interests or potential conflicts of interest. The funders had no involvement in the collection, analysis and interpretation of the data, in the writing of the report, or in the decision to submit these results for publication.

Publisher Copyright:
© 2018 Elsevier B.V.


  • 5 Hz
  • Major depressive disorder
  • Posttraumatic stress disorder
  • Repetitive transcranial magnetic stimulation


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