Nutrition + CBT + TMS: an integrative approach for depressive and anxiety symptoms for treatment-resistant depression (TRD) patients.

Background: Often the management of TRD patients combines TMS with CBT. Studies show that a poor diet can both cause and aggravate depressive and anxiety symptoms and therefore we suggest that adding nutrition sessions for the treatment of TRD patients would impact positively on the efficacy of the treatment. Methods: 34 patients (aged between 18 to 64 years old) were diagnosed with treatment resistant depression. The therapy consisted of 35 bilateral TMS sessions plus 2 nutritional and 4 CBT sessions over the course of 4 weeks. The target was located by neuronavigation over the right and left dorsolateral prefrontal cortex. HAM-A and PHQ-9 scales were used for pre and post treatment evaluations. Results: All 34 patients completed the study without significant side effects. Response was 91% and remission 56% for depressive symptoms. 94% of the patients improved their anxiety symptoms. Conclusions: An integrative approach with nutrition, CBT and TMS appears to be well tolerated and might be a satisfactory intervention to improve depressive and anxiety symptoms for TRD patients. This is not a sham-active protocol thus is not possible to measure the placebo response. Further search is needed to corroborate these findings. Conflicts of Interests: None to report. Funding: self-funding Disclosures: Department of Neurology, Neuropsychiatry and Psychology, Neuroinnovation Center, Quito, Ecuador. South America