This pilot study aims to establish the feasibility of offering PCT live or online to MDD patients in remission due to rTMS by measuring treatment adherence using descriptive data and daily affect. Results will be used to improve patient compliance in a larger RCT investigating the effects of PCT after rTMS.

Since 2018, repetitive Transcranial Magnetic Stimulation (rTMS) is a first line recommendation in the Netherlands for patients with Major Depressive Disorder (MDD), not responding to at least two treatments. Most studies investigated effectiveness up to 6 weeks after treatment, while relapse happens frequently in a larger time frame and occurs in approx. 60-90 percent of patients with a recurring course of depression. Relapse prevention is therefore of substantial importance, however literature on (maintenance) therapy after successful rTMS treatment is scarce and of low quality. Preventive Cognitive Therapy (PCT) is effective in reducing relapse risk. To our knowledge, PCT after rTMS has not been investigated as a maintenance strategy.

With the rTMS-PCT study, we compare treatment adherence in either online or face to face PCT offered to responding rTMS patients in order to calculate effect sizes of a larger RCT. All included patients will fill in questionnaires regarding their depressive symptoms directly after rTMS when reaching (partial) remission, directly after completing PCT, 3 months after PCT and 6 months after PCT in order to monitor duration of remission.

rTMS-PCT will recruit 20 patients (10 online PCT and 10 face-to-face PCT), age 18-65 years, who have positively responded to rTMS treatment for MDD (at least 50% reduction of depressive complaints).

rTMS-PCT is coordinated by the department of psychiatry of the Amsterdam UMC, location AMC. This study is actively enrolling participants as of June 2024. rTMS-PCT is supported by The Netherlands Organization for Health Research and Development (ZonMW; grant number 10390052210062).