Cambridge Health Alliance

A course of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression runs about 36 sessions, each requiring a choice of stimulation type, intensity and laterality, and clinicians have lacked evidence-based guidance for those session-level decisions. A reinforcement-learning policy trained on electronic health records from 1609 adults across 19 clinic groups in one behavioral health network was tested on 370 patients at six held-out clinics: sessions where clinicians matched its recommendation showed 0.788 points greater next-session PHQ-9 improvement (95% CI 0.634–0.940). Following every recommendation was projected to add 3.22 points over a first episode, but this is a retrospective association without prospective validation.

A course of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression runs about 36 sessions, each requiring a choice of stimulation type, intensity and laterality, and clinicians have lacked evidence-based guidance for those session-level decisions. A reinforcement-learning policy trained on electronic health records from 1609 adults across 19 clinic groups in one behavioral health network was tested on 370 patients at six held-out clinics: sessions where clinicians matched its recommendation showed 0.788 points greater next-session PHQ-9 improvement (95% CI 0.634–0.940). Following every recommendation was projected to add 3.22 points over a first episode, but this is a retrospective association without prospective validation.