Substance Use is Not Associated with Antidepressant Response to Transcranial Magnetic Stimulation
- 1Vanderbilt University Medical Center
Abstract
BackgroundSubstance use is common among individuals with depression. Transcranial magnetic stimulation (TMS) is an effective treatment for depression, but current clinical guidelines have discouraged TMS treatment for individuals with depression and co-occurring substance use given concerns for limited efficacy. However, limited data exists on whether substance use affects response to TMS.
MethodsUsing electronic health record data from patients who received a standard course of TMS for major depressive disorder at an academic medical center, we investigated associations between substance use frequency and response to TMS, defined as change in Patient Health Questionnaire-9 (PHQ-9) scores. Substance use frequency was extracted for alcohol, cannabis, nicotine, stimulants, benzodiazepines, opioids, inhalants, psychedelics, and other drugs. We performed ANCOVA and multiple regression analyses to predict change in PHQ-9 score based on substance use frequency, controlling for pre-TMS PHQ-9 score, age, sex, and number of TMS sessions received.
ResultsWe extracted data from 219 TMS courses. Alcohol was the substance used most commonly (34.2%), followed by prescription benzodiazepines (28.3%), and prescription stimulants (21.0%). Across all substance categories, substance use was not associated with change in PHQ-9 score (all ps > 0.05, Cohens d=0.00 to 0.30). In multiple regression models to compare individual levels of substance use frequency (e.g., daily use vs. no use), level of substance use was not associated with change in PHQ-9 score (all ps > 0.05). The range of plausible effects of substance use frequency on PHQ-9 change was generally below the minimal clinically important difference for PHQ-9, suggesting substance use was unlikely to have a meaningful clinical effect on antidepressant response to TMS.
ConclusionsLow to moderate substance use does not have a clinically significant effect on antidepressant response to TMS. Low-level substance use should not exclude individuals with depression from receiving TMS.
Related
- Temporal association between adjunctive repetitive transcranial magnetic stimulation and seizure reduction in a pediatric patient with DNM1L-associated EMPF1: a case report
- Peripheral Brain-Derived Neurotrophic Factor Changes and Clinical Response to Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in Major Depressive Disorder: A Systematic Review.
- Training and Experiential Factors Associated With Transcranial Magnetic Stimulation Referral Readiness Among Psychiatric Providers.
- A single session of transcranial static magnetic stimulation placed over the visual cortex was not associated with measurable changes in dynamic stability or static postural control in individuals with recurrent lateral ankle sprains: a randomized double-blind placebo-controlled trial.
- Transcranial Direct Current Stimulation and Cranial Electrotherapy Stimulation in Athletes: Optimizing Athletic Performance and Sleep Quality Through Neuromodulation
BibTeX
@misc{chesley2026substance,
title = {{Substance Use is Not Associated with Antidepressant Response to Transcranial Magnetic Stimulation}},
author = {J. Chesley and K. Biernacki and J. Vanleuven and J. P. Doran and I. Yazgan and G. Yildiz and D. A. Gonzalez and S. Y. Wagner and K. LeBaron and E. Marrero and T. Osama and S. Vandekar and H. B. Ward},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.01.26361949},
url = {https://www.medrxiv.org/content/10.64898/2026.09.01.26361949v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Substance Use is Not Associated with Antidepressant Response to Transcranial Magnetic Stimulation
AU - J. Chesley
AU - K. Biernacki
AU - J. Vanleuven
AU - J. P. Doran
AU - I. Yazgan
AU - G. Yildiz
AU - D. A. Gonzalez
AU - S. Y. Wagner
AU - K. LeBaron
AU - E. Marrero
AU - T. Osama
AU - S. Vandekar
AU - H. B. Ward
PY - 2026
DA - 2026/09/01
PB - medRxiv
DO - 10.64898/2026.09.01.26361949
UR - https://www.medrxiv.org/content/10.64898/2026.09.01.26361949v1
AB - BackgroundSubstance use is common among individuals with depression. Transcranial magnetic stimulation (TMS) is an effective treatment for depression, but current clinical guidelines have discouraged TMS treatment for individuals with depression and co-occurring substance use given concerns for limited efficacy. However, limited data exists on whether substance use affects response to TMS. MethodsUsing electronic health record data from patients who received a standard course of TMS for major depressive disorder at an academic medical center, we investigated associations between substance use frequency and response to TMS, defined as change in Patient Health Questionnaire-9 (PHQ-9) scores. Substance use frequency was extracted for alcohol, cannabis, nicotine, stimulants, benzodiazepines, opioids, inhalants, psychedelics, and other drugs. We performed ANCOVA and multiple regression analyses to predict change in PHQ-9 score based on substance use frequency, controlling for pre-TMS PHQ-9 score, age, sex, and number of TMS sessions received. ResultsWe extracted data from 219 TMS courses. Alcohol was the substance used most commonly (34.2%), followed by prescription benzodiazepines (28.3%), and prescription stimulants (21.0%). Across all substance categories, substance use was not associated with change in PHQ-9 score (all ps > 0.05, Cohens d=0.00 to 0.30). In multiple regression models to compare individual levels of substance use frequency (e.g., daily use vs. no use), level of substance use was not associated with change in PHQ-9 score (all ps > 0.05). The range of plausible effects of substance use frequency on PHQ-9 change was generally below the minimal clinically important difference for PHQ-9, suggesting substance use was unlikely to have a meaningful clinical effect on antidepressant response to TMS. ConclusionsLow to moderate substance use does not have a clinically significant effect on antidepressant response to TMS. Low-level substance use should not exclude individuals with depression from receiving TMS.
ER -