JAMA Netw Open

Repetitive magnetic brain stimulation matches lithium in preventing depression relapse

June 23, 2025

Maintenance low-frequency repetitive transcranial magnetic stimulation (rTMS) is as effective as lithium for relapse prevention in treatment-resistant depression (TRD), with a superior safety and tolerability profile.

Study details: The MAINT-R randomized trial enrolled 75 adults with TRD who responded to an acute course of bilateral rTMS. Participants were randomized to receive either 24 weeks of weekly low-frequency (1 Hz) right dorsolateral prefrontal rTMS (900 pulses/session at 120% resting motor threshold) or lithium pharmacotherapy, both in addition to stable venlafaxine dosing. The primary outcome was the between-group difference in Montgomery-Åsberg Depression Rating Scale (MADRS) scores at week 24; secondary outcomes included time to relapse (MADRS ≥22) and adverse events.

Results: At 24 weeks, there was no significant difference in MADRS scores between rTMS and lithium groups (mean difference, 0.3 points; 95% confidence interval [CI], -2.7 to 3.3; P = 0.84). Relapse rates were identical (7 patients per group), and survival analysis showed no meaningful difference in time to relapse. Adverse events were significantly more frequent with lithium (16 vs. 3; odds ratio, 7.10, 95% CI, 1.84-27.49; P = 0.005).

Source:

Noda Y, et al. (2025, June 2). JAMA Netw Open. Nakajima S. Repetitive Transcranial Magnetic Stimulation as Maintenance Treatment of Depression: The MAINT-R Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40522661/