The mood log – A tool for clustered maintenance TMS

Transcranial magnetic stimulation (TMS) is a safe and effective treatmentof treatment resistant major depressive disorder (MDD). However, MDD is achronic disorder and relapse is common. The leading method of managing those casesof MDD who respond to TMS, but continue to relapse, is to provide maintenanceTMS – short courses of 5 treatments over 2.5 days, repeat at monthly (or greater)intervals. The strategy is to increase the interval between treatment clusters and forpatients to be discharged when they have been able to remain well for a couple ofmonths. However, patients and doctors are both frequently apprehensive aboutincreasing the between cluster interval, and patients tend to remain in treatmentprograms for long periods. We present a protocol and instrument to assist in movingfrom treatment to discharge, which we have found helpful.