Major depressive disorder (MDD) is a severe and highly prevalence disease with potentially life threatening illness and high level of morbidity and mortality. Traditional pharmacological strategies are not always sufficiently effective and side effects are not rare and may be the cause of discontinuation, particularly in the long-term treatment.

rTMS could be an alternative strategy for long-term treatment of treatment-resistant depression (TRD).

to evaluate the efficency of maintenance rTMS in a one-year double blind randomized controlled study for TRD patients.

55 TRD patients were involved in a single site trial with two phases: an acute phase (phase I) in which all the participants received active high-frequency stimulation during 4 blocks of five consecutive working days (Monday to Friday) in an open-label design and a maintenance phase (phase II) in which responders (> 49% HDRS-17 reduction from baseline) were randomized in two arms with sham or active highfrequency rTMS maintenance treatment for the eleven following months.

of 55 patients in the acute trials, 33 were responders and 14 accepted to be included in the phase II. Delta HDRS score show a significantly difference for M1-M4 (p=.003), M1-M5 (p=.004) and M1-M6 (p=.043) between the active and the placebo group.

rTMS could be a novel strategy to prevent relapse in TRD patients who respond to an acute rTMS treatment and 1 session per week may be able to prevent relapses. These results need to be confirmed in a larger sample.