Treatment-Resistant Depression Reversed with TMS
A 34-year-old professional regained full daily function after three failed medication trials, following a structured course of TMS therapy under Dr. Prakhar D. Jain in Mumbai.
Patient identity withheld per confidentiality guidelines. Clinical details are presented as a representative account for educational purposes.
Patient Profile
| Age | 34 years |
| Gender | Male |
| Occupation | Working Professional (Finance Sector) |
| City | Mumbai |
| Presenting Complaint | Persistent low mood, loss of interest, disturbed sleep, and impaired concentration despite ongoing antidepressant treatment. |
| Diagnosis | Major Depressive Disorder, Treatment-Resistant |
| Duration of Issue | Approximately 4 years |
| Previous Treatments | Three adequate antidepressant trials from different classes; supportive psychotherapy. |
| Date of Procedure | January 2026 |
| Outcome | Excellent, sustained remission-level improvement |
The Problem
Condition
The patient was diagnosed with treatment-resistant major depressive disorder, a form of depression that does not respond adequately to at least two correctly dosed antidepressant trials of sufficient duration. His illness was moderately severe, with a PHQ-9 score of 19 at intake. Symptoms were continuous rather than episodic, and included pervasive low mood, early morning awakening, reduced appetite, psychomotor slowing, and marked difficulty sustaining attention through routine work tasks.
Emotional and Psychological Impact
The condition had steadily eroded the patient’s professional and personal life over four years. He had taken two extended leaves of absence from work in the preceding twelve months and had withdrawn from social engagements almost entirely. Two antidepressants had produced no meaningful benefit, while a third offered only partial relief accompanied by weight gain and daytime sedation that further compromised his performance. By the time he presented to the clinic, he described a settled belief that his illness was permanent, alongside significant anticipatory anxiety about losing his employment.
Consultation and Treatment Plan
What Was Assessed During the Consultation?
A comprehensive psychiatric evaluation was conducted by Dr. Prakhar Jain, covering the following:
- Detailed illness history, symptom pattern, and severity scoring using the PHQ-9
- Verification of prior medication trials for adequacy of dose, duration, and adherence
- Screening for secondary causes, including thyroid function, metabolic parameters, and sleep disturbance
- Safety assessment, family history, and suitability for neuromodulation therapy
Why Was TMS Therapy Chosen?
After confirming treatment resistance, TMS therapy was recommended for the following clinical reasons:
- Repetitive Transcranial Magnetic Stimulation (rTMS) is an established, evidence-based intervention for depression that has not responded to pharmacotherapy
- It is non-invasive and requires no anaesthesia, allowing the patient to continue working throughout the treatment course
- It carries no systemic side effects such as sedation or weight gain, which had already compromised his medication adherence
- High-frequency stimulation of the left dorsolateral prefrontal cortex directly targets the cortical hypoactivity associated with depressive illness
The agreed plan comprised 30 rTMS sessions over six weeks, five sessions per week, alongside a single well-tolerated antidepressant and fortnightly supportive psychotherapy.
Procedure Details
Step-by-Step Overview
Motor threshold determination performed in the first session to calibrate individualised, safe stimulation intensity
Treatment site localised over the left dorsolateral prefrontal cortex using standardised measurement
High-frequency rTMS delivered while the patient remained awake and seated
Each session lasted approximately 20 to 30 minutes, with the patient returning to work the same day
Weekly PHQ-9 scoring performed to monitor response objectively
Stimulation parameters reviewed and adjusted by Dr. Prakhar Jain at each weekly assessment
Procedure Facts
Post-Treatment Results
The response followed the expected TMS trajectory. Sleep quality and energy levels improved by the third week, followed by a clear lift in mood and interest between weeks four and five. At the end of the six-week course, the PHQ-9 score had reduced from 19 to 6, representing a shift from moderately severe depression to the mild range. The patient resumed full working days without leave, and his previous sedating antidepressant was tapered under the supervision of his Psychiatrist in Mumbai.
Outcomes at a Glance
Patient Feedback
“After three medicines failed, I had stopped believing anything would work. TMS was far easier than I expected, and by the fourth week I noticed I was looking forward to things again. That had not happened in years.”
Post-Procedure Care and Recovery
Instructions Given to the Patient
Continue the single maintained antidepressant at the prescribed dose without interruption
Attend monthly psychiatric reviews for the first six months following completion of the course
Maintain a fixed sleep and wake schedule with regular physical activity
Track early warning signs of relapse, including sleep disturbance and social withdrawal, with family support
Report any recurrence of symptoms promptly so that booster TMS sessions can be scheduled if indicated
Recovery Timeline
| Timeline | Recovery Progress |
|---|---|
| Day 1–3 | Mild scalp sensitivity after initial sessions; all routine activities continue unrestricted. |
| Week 1–2 | Mild scalp discomfort settles; no change in routine required; sessions continue alongside normal work. |
| Week 3 | Sleep and energy show measurable improvement on weekly scoring. |
| Week 4–5 | Mood, interest, and concentration improve substantially. |
| Week 6 | Course completed; PHQ-9 reduced to 6; sedating medication taper initiated. |
| Month 3 | Stable functioning confirmed; medication taper completed. |
| Month 6 | Sustained response confirmed at follow-up; routine monitoring continued. |
Frequently Asked Questions
Q1. What is treatment-resistant depression and can it be treated?
It is depression that has not improved after at least two adequate antidepressant trials. It remains treatable, and TMS therapy offered by Dr. Prakhar Jain in Mumbai shows strong outcomes in such cases.
Q2. How long does a TMS therapy course take in Mumbai?
A standard course involves 20 to 30 outpatient sessions over four to six weeks, each lasting about 20 to 30 minutes.
Q3. Is there any recovery time after TMS sessions?
None. Patients remain awake during treatment and resume all normal activities immediately after each session.
Q4. Why choose Dr. Prakhar Jain for TMS therapy in Mumbai?
Dr. Prakhar D. Jain brings over 13 years of psychiatric experience and a multidisciplinary team in Mumbai. Every TMS course is individually calibrated and monitored with weekly objective scoring.
Q5. Are the results of TMS therapy permanent?
Many patients maintain improvement long term with structured follow-up. Booster sessions can be provided if early signs of recurrence appear.
Q6. Is TMS therapy safe?
Yes. TMS is a well-tolerated, non-invasive treatment. The most common side effect is mild, temporary scalp discomfort.
