Repetitive transcranial magnetic stimulation (rTMS) for treatment of auditory hallucinations in an Australian public hospital: A case-series

Auditory hallucinations (AH) are common in people with a psychotic illness, and they can cause significant distress and functional impairment. AH typically respond poorly to antipsychotic medications, and up to 30% of people experience treatment-resistant AH. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, low-risk treatment option that has shown potential for treatment-resistant AH. However, the literature demonstrates mixed findings, and there are a lack of contemporary studies from Australian public hospital settings. This case series included five participants with a psychotic illness and AH, who received rTMS for AH in a large public, tertiary, metropolitan mental health service in Australia. rTMS was assessed by subjective and objective measures, including review of the clinical notes and Auditory Hallucination Rating Scale (AHRS) and Montgomery-Asberg Depression Rating Scale (MADRS) scores collected pre- and post-rTMS. This case series showed mixed findings about rTMS for AHs: two participants demonstrated improvements in AH following rTMS (with AHRS scores decreasing by 9 and 18 points respectively), whilst one demonstrated worsening AH (with AHRS increasing by 6 points), one showed minimal changes, and one had early cessation of their rTMS treatment due to clinical deterioration without a post-treatment score. While all participants experienced improvements in mood and anxiety, these changes were modest for some cases (e.g., MADRS change ranged from -1 to -21) and may not represent clinically significant improvements. Overall, rTMS was well tolerated. This case series demonstrates the feasibility of rTMS for treatment-resistant AH. However, further research on efficacy is essential.