{"id":"doi:10.1016/j.jad.2026.122107","kind":"article","title":"Comparing transcranial magnetic stimulation and esketamine treatment response trajectories in resistant depression","authors":["Benster LL","Kohn JN","Wade B","Stapper N","Weissman CR","Miron JP","Daskalakis ZJ","Appelbaum LG"],"author_count":8,"year":2026,"published":"2026-06-07","venue":"Journal of affective disorders","cited_by":1,"doi":"10.1016/j.jad.2026.122107","arxiv_id":null,"nct_id":null,"source_url":"https://doi.org/10.1016/j.jad.2026.122107","archive_url":"https://space-kitty.com/papers/doi:10.1016/j.jad.2026.122107","updated":null,"pmid":"42259490","pmcid":"PMC13401942","openalex_id":null,"pdf_url":"https://europepmc.org/articles/PMC13401942/pdf","abstract":"Objective Repetitive transcranial magnetic stimulation (rTMS) and intranasal esketamine are FDA-approved for treatment-resistant depression (TRD), yet comparative real-world data on response trajectories and predictors of outcomes remain limited. Methods A retrospective analysis was performed using electronic medical records from UC San Diego Health. Adults with TRD treated with rTMS (n = 279) or intranasal esketamine (n = 93) between 2017 and 2025 were included. The primary outcome was clinical response (≥50% PHQ-9 reduction). Time-to-response was assessed using inverse probability treatment weighted (IPTW) Cox models; Kaplan-Meier curves and log-rank tests provided descriptive comparisons. Covariates included age, trauma history, anxiety comorbidity, benzodiazepine use, tobacco use history, BMI, and baseline symptom severity. Secondary outcomes included remission (PHQ-9 < 5) and suicidal ideation (SI). Results Esketamine demonstrated earlier response over 90 days (RMST difference = -11.94 days) and faster time-to-response in the IPTW Cox model (HR = 1.62, p = 0.005); KM estimates showed median response at 36 vs. 49 days (p = 0.0096) with convergence by ∼90 days. Cumulative response and remission rates were numerically higher for esketamine (68.8% / 45.2%) than rTMS (59.4% / 40.1%), supporting a speed-of-response difference rather than superior overall efficacy. SI improved more rapidly with esketamine (median 9 vs. 26 days; p = 0.001). In the rTMS cohort, comorbid anxiety (HR = 0.69, p = 0.039) and benzodiazepine use (HR = 0.73, p = 0.046) predicted slower response, while former tobacco use predicted faster response (HR = 1.31, p = 0.006). No significant predictors emerged for esketamine. Conclusions Esketamine was associated with earlier observed antidepressant and anti-suicidal improvement than rTMS. Baseline factors, including benzodiazepine use, may help inform expectations regarding rTMS response trajectory.","abstract_license":"CC-BY (article license as recorded by Europe PMC; abstract reproduced unmodified apart from markup removal)","license":"CC-BY","is_open_access":true,"retracted":false,"peer_reviewed":null,"categories":[],"details":null,"provenance":"europepmc","attribution":"Abstract of \"Comparing transcranial magnetic stimulation and esketamine treatment response trajectories in resistant depression\" by Benster LL, Kohn JN, Wade B et al., https://doi.org/10.1016/j.jad.2026.122107, used under its Creative Commons Attribution license (CC-BY); markup removed, otherwise unmodified.","topics":[{"slug":"psychiatric-therapeutics","name":"Novel Psychiatric Therapeutics","domain_slug":"neuroscience"}],"cited_in_dossiers":[]}