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April 28, 2026 · 5 min read
PHQ-9 as a conversation, not a checkbox
Outcome measures only matter if they change clinical conversations. Here's how to wire weekly PHQ-9 into a TMS course.
By Faisal Rafiq, MD
Measurement-based care isn't a documentation exercise. It's how you and the patient stay aligned on whether the course is working.
Cadence
Weekly PHQ-9 is the floor. Mid-course, a flat or rising score is the cue for a treatment-team conversation — not a panic.
What the trend should show
By session 18 of 36, most responders show a meaningful drop. If the slope is flat, options include retitration, mapping confirmation, or augmentation.
What to share with referrers
A one-page course summary with the PHQ-9 line, the protocol, total pulses, and any motor-threshold changes does more for the referral relationship than any newsletter.