Repetitive transcranial magnetic stimulation for treatment-resistant depression in Singapore: a retrospective, naturalistic study
- 1Department of Psychiatry, Khoo Teck Puat Hospital, Singapore, Singapore
Abstract
Introduction: Naturalistic repetitive transcranial magnetic stimulation (rTMS) outcome data for treatment-resistant depression remain limited in Southeast Asia. This retrospective study describes such outcomes from a general hospital in Singapore.
Method: 28 outpatients received rTMS (10Hz high-frequency or intermittent theta-burst) targeting the left dorsolateral prefrontal cortex (F3 scalp position) between May 2022 and May 2025. Treatment-resistant depression was defined as failing ≥2 antidepressant classes for ≥6 weeks each. The primary outcome was change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score; secondary outcomes included the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16), the Depression, Anxiety and Stress Scale-21 (DASS-21), the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), the Clinical Global Impression-Severity (CGI-S), and the Global Assessment of Functioning (GAF).
Results: Despite 85.7% of patients having failed ≥3 antidepressant classes, the mean MADRS score decreased by 15.8 (SD 9.1), from 29.6 (SD 7.6) to 13.9 (SD 11.1, p<0.001). This corresponded to a 67.9% response rate and a 57.1% remission rate. All secondary measures (QIDS-SR16, DASS-21, Q-LES-Q-SF, CGI-S, and GAF) showed significant improvements (all p<0.001). Shorter episode duration and higher baseline quality of life were significantly associated with remission.
Conclusion: We report favourable response (67.9%) and remission (57.1%) rates within a general hospital cohort in Singapore following standardised rTMS targeting the left dorsolateral prefrontal cortex (approximated by the F3 position), despite extensive prior antidepressant medication failure. These findings contribute real-world data to the limited Southeast Asian literature on standardised rTMS protocols for treatment-resistant depression in general hospital and similar clinical settings.
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BibTeX
@article{tay2026repetitive,
title = {{Repetitive transcranial magnetic stimulation for treatment-resistant depression in Singapore: a retrospective, naturalistic study}},
author = {Yi Hang Tay and Ern Wei Christabel Thng},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1924135},
url = {https://doi.org/10.3389/fpsyt.2026.1924135},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Repetitive transcranial magnetic stimulation for treatment-resistant depression in Singapore: a retrospective, naturalistic study
AU - Yi Hang Tay
AU - Ern Wei Christabel Thng
PY - 2026
DA - 2026/10/12
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1924135
UR - https://doi.org/10.3389/fpsyt.2026.1924135
AB - Introduction: Naturalistic repetitive transcranial magnetic stimulation (rTMS) outcome data for treatment-resistant depression remain limited in Southeast Asia. This retrospective study describes such outcomes from a general hospital in Singapore. Method: 28 outpatients received rTMS (10Hz high-frequency or intermittent theta-burst) targeting the left dorsolateral prefrontal cortex (F3 scalp position) between May 2022 and May 2025. Treatment-resistant depression was defined as failing ≥2 antidepressant classes for ≥6 weeks each. The primary outcome was change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score; secondary outcomes included the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16), the Depression, Anxiety and Stress Scale-21 (DASS-21), the Quality of Life, Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), the Clinical Global Impression-Severity (CGI-S), and the Global Assessment of Functioning (GAF). Results: Despite 85.7% of patients having failed ≥3 antidepressant classes, the mean MADRS score decreased by 15.8 (SD 9.1), from 29.6 (SD 7.6) to 13.9 (SD 11.1, p<0.001). This corresponded to a 67.9% response rate and a 57.1% remission rate. All secondary measures (QIDS-SR16, DASS-21, Q-LES-Q-SF, CGI-S, and GAF) showed significant improvements (all p<0.001). Shorter episode duration and higher baseline quality of life were significantly associated with remission. Conclusion: We report favourable response (67.9%) and remission (57.1%) rates within a general hospital cohort in Singapore following standardised rTMS targeting the left dorsolateral prefrontal cortex (approximated by the F3 position), despite extensive prior antidepressant medication failure. These findings contribute real-world data to the limited Southeast Asian literature on standardised rTMS protocols for treatment-resistant depression in general hospital and similar clinical settings.
SN - 1664-0640
ER -