Schedule of Events | Symposia

Sudden Gains as an Indicator of Improved Depression Symptom Outcomes in iTBS TMS

Poster Session E - Monday, March 31, 2025, 2:30 – 4:30 pm EDT, Back Bay Ballroom/Republic Ballroom

Jolin Chou¹ (joc4023@med.cornell.edu), Indira Summerville¹, Megan E. Chang¹, Claire Ho¹, Megan Johnson¹, Nicola Manfredi¹, Hayley Seltzberg¹, Benjamin Zebley¹, Lindsay Victoria¹, Conor Liston¹, Nili Solomonov¹, Immanuel Elbau¹; ¹Weill Cornell Medicine

Sudden gains, characterized by rapid, non-linear reductions in symptoms between consecutive treatment sessions, are a common phenomenon in psychotherapy. Previous research in psychotherapy for depression suggests sudden gains as a predictor of sustained post-treatment response. However, sudden gains and their effect on long-term outcomes have not been characterized in neuromodulation interventions like repetitive transcranial magnetic stimulation (rTMS) for depression. This study investigates sudden gains as a predictor of symptom improvement for individuals (n=89; aged 22-63 years) who responded to fMRI-guided intermittent theta-burst (iTBS) TMS targeting the frontoparietal and cognitive control networks of the prefrontal cortex. Participants completed 30 daily treatments over 6-8 weeks. Depression symptom severity was monitored using a standardized depression severity scale administered at baseline, weekly during treatment, and 1-, 4-, and 12-weeks post-treatment. Of the 89 responders, 17 (19%) experienced a sudden gain during treatment, which occurred uniformly across the 6-8 weeks of sessions. Results showed that from the end of treatment to 12-weeks post-treatment, depression severity scores were significantly lower among individuals who experienced a sudden gain compared to those who did not (M=4.35, SE=1.61, p=0.009). No difference was found in depression severity between the groups while individuals received active treatment (p=0.229). These results support prior findings associating sudden gains to improved post-treatment outcomes and extend this phenomenon as a potential indicator of treatment outcomes in TMS. Future research should examine the neurobiological characteristics of those who experience sudden gains during interventional treatments like TMS to better understand the clinical and cognitive mechanisms facilitating sustained improvement.

Topic Area: OTHER