{"doi":"10.1016/j.brs.2023.05.019","title":"Differential response to H-coil repetitive transcranial magnetic stimulation before versus after the first COVID-19 shutdown","abstract":"Depression rates increased following the onset of the COVID-19 pandemic in 2020 [[1]Twenge J.M. Joiner T.E.U.S. Census Bureau‐assessed prevalence of anxiety and depressive symptoms in 2019 and during the 2020 COVID‐19 pandemic.Depress Anxiety. 2020; 37: 954https://doi.org/10.1002/DA.23077Crossref PubMed Scopus (0) Google Scholar,[2]Khubchandani J. Sharma S. Webb F.J. Wiblishauser M.J. Bowman S.L. Post-lockdown depression and anxiety in the USA during the COVID-19 pandemic.J Publ Health. 2021; 43: 246-253https://doi.org/10.1093/pubmed/fdaa250Crossref Scopus (58) Google Scholar]. To our knowledge, no studies have investigated the impact of the COVID-19 pandemic on rTMS effectiveness for depression. We hypothesized that rTMS response rates increased after the first COVID-19 shutdown. The rTMS protocol remained unchanged during the pandemic, but secondary factors related to rTMS treatment (e.g., behavioral activation, therapeutic alliance, socialization, etc.) might be more impactful during an extended period of social isolation. We tested this hypothesis by investigating change in rTMS response rates over the course of the pandemic. We conducted a retrospective chart review of outpatients who completed a course of H-coil rTMS (25–35 sessions) for depression at McLean Hospital in Belmont, MA between June 2015 and April 2022. All patients completed the Quick Inventory of Depressive Symptomatology (QIDS) before and after their rTMS treatment course. Patients were divided into two groups—pre-shutdown and post-shutdown—based on whether treatment concluded before or after March 15, 2020, the first COVID-19 shutdown in the United States [[3]Centers for Disease Control and PreventionCDC museum COVID-19 timeline.https://www.cdc.gov/museum/timeline/covid19.html#Date: 2022Date accessed: April 3, 2023Google Scholar]. As a secondary analysis we compared patients who completed treatment pre-shutdown, post-shutdown 2020, 2021, and 2022. Unpaired two-tailed t-tests were conducted to assess between-group differences in percentage change and total change in QIDS. Z-tests for proportions were used to assess between-group differences in response rate (≥50% improvement on QIDS) and remission rate (post-treatment QIDS ≤5) [[4]Rush A.J. Bernstein I.H. Trivedi M.H. Carmody T.J. Wisniewski S. Mundt J.C. et al.An evaluation of the Quick inventory of depressive Symptomatology and the Hamilton rating scale for depression: a sequenced treatment alternatives to relieve depression trial report.Biol Psychiatr. 2006; 59: 493-501https://doi.org/10.1016/j.biopsych.2005.08.022Abstract Full Text Full Text PDF PubMed Scopus (337) Google Scholar]. An autoregressive integrated moving average (ARIMA) was used to assess for a long-term time trend independent of the shutdown. Finally, to determine whether the effect was unique to the shutdown relative to other time points, we compared the change in percentage improvement at the shutdown to the change in percentage improvement at every other monthly time point (the first and last 6-month periods were excluded from because it would lead to a small sample size at the tails). Overall, 445 patients ages 14–90 (47.39 ± 17.30) met inclusion criteria. The groups did not significantly differ in terms of age (48.18 ± 16.613 pre-shutdown vs 46.18 ± 18.285 post-shutdown) or sex composition (59% ± 49% pre-shutdown vs 68% ± 47% post-shutdown). Most patients (approximately 91%) received 1980 pulses per treatment at their left dorsolateral prefrontal cortex (DLPFC). The remainder (approximately 9%) received right sided or bilateral treatment with a variable number of pulses. Pulses administered did not significantly differ between groups. The pre-shutdown group (n = 267 patients) was larger than the post-shutdown group (n = 178 patients). There was no significant difference in baseline QIDS score between the groups (19.37 ± 6.15 pre-shutdown vs 19.30 ± 5.99 post-shutdown, t(386) = 0.12, p = .906). Both groups showed significant improveme","journal":"Brain stimulation","year":2023,"id":407557,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9722,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":670462,"name":"Joseph J. Taylor","orcid":"0000-0002-9185-0427","position":1,"is_corresponding":false},{"id":304029,"name":"Joshua C. Brown","orcid":"0000-0003-0887-2746","position":2,"is_corresponding":false},{"id":484180,"name":"Stephen J. Seiner","orcid":null,"position":3,"is_corresponding":false},{"id":230803,"name":"Shan H. Siddiqi","orcid":"0000-0002-0967-9289","position":4,"is_corresponding":false},{"id":1186474,"name":"Claudia R. Becker","orcid":"0009-0003-1239-8650","position":0,"is_corresponding":true}],"reference_count":8,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:21:10.867368Z","pmid":"37230463","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}