19-year-old female with treatment-resistant depression, MDD (major depressive disorder) and severe GAD (generalized anxiety disorder).

  • Treated with 6-7 antidepressants since age of 13
  • Persistent depression and anxiety
  • Initial PHQ [patient health questionnaire]: 20
  • Initial GAD [GAD assessment score]: 20 [note: Score 0-4: Minimal Anxiety. Score 5-9: Mild Anxiety. Score 10-14: Moderate Anxiety. Score greater than 15: Severe Anxiety.]
  • Presented for Accelerated TMS therapy for MDD over the left DLPFC and GAD over the right DLPFC (Patel protocol) – 50 sessions of high-frequency TMS (iTBS) over the L DLPFC for MDD and 50 sessions of cTBS over the R DLPFC for GAD in 5 days (20 sessions/day for 5 days)i. Reported slight “TMS dip” with worsening of mood on day 2 (33% can experience dip by day 2) ii. Day 3: at midday, she was reporting less fatigue and improvements in mood by at least 50% with reduced depressed mood and anxiety; mother also reported noting significant changes starting to emerge.iii. Day 4: continued noting improvements in mood with no fatigue and somnolence as she was experiencing prior to starting treatment.iv. Day 5: reported feeling extremely well with smiling and reporting not feeling depressed and mother also concurring with the same level of observed improvement.
  • Final PHQ-9 after 5 days of treatment: 2
  • Final GAD-7 after 5 days of treatment: 5

Patient Health Questionnaire #9