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Dalton B, Bartholdy S, McClelland J, Kekic M, Rennalls SJ, Werthmann J, Carter B, O’Daly OG, Campbell IC, David AS, Glennon D, Kern N, Schmidt U. Randomised controlled feasibility trial of real versus sham repetitive transcranial magnetic stimulation treatment in adults with severe and enduring anorexia nervosa: the TIARA study. BMJ Open 2018; 8:e021531. [PMID: 30012789 PMCID: PMC6082449 DOI: 10.1136/bmjopen-2018-021531] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/09/2018] [Accepted: 05/15/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Treatment options for severe, enduring anorexia nervosa (SE-AN) are limited. Non-invasive neuromodulation is a promising emerging intervention. Our study is a feasibility randomised controlled trial of repetitive transcranial magnetic stimulation (rTMS) in individuals with SE-AN, which aims to inform the design of a future large-scale trial. DESIGN Double-blind, parallel group, two-arm, sham-controlled trial. SETTING Specialist eating disorders centre. PARTICIPANTS Community-dwelling people with anorexia nervosa, an illness duration of ≥3 years and at least one previous completed treatment. INTERVENTIONS Participants received 20 sessions (administered over 4 weeks) of MRI-guided real or sham high-frequency rTMS to the left dorsolateral prefrontal cortex in addition to treatment-as-usual. OUTCOMES Primary outcomes were recruitment, attendance and retention rates. Secondary outcomes included body mass index (BMI), eating disorder symptoms, mood, quality of life and rTMS safety and tolerability. Assessments were conducted at baseline, post-treatment and follow-up (ie, at 0 month, 1 month and 4 months post-randomisation). RESULTS Thirty-four participants (17 per group) were randomly allocated to real or sham rTMS. One participant per group was withdrawn prior to the intervention due to safety concerns. Two participants (both receiving sham) did not complete the treatment. rTMS was safe and well tolerated. Between-group effect sizes of change scores (baseline to follow-up) were small for BMI (d=0.2, 95% CI -0.49 to 0.90) and eating disorder symptoms (d=0.1, 95% CI -0.60 to 0.79), medium for quality of life and moderate to large (d=0.61 to 1.0) for mood outcomes, all favouring rTMS over sham. CONCLUSIONS The treatment protocol is feasible and acceptable to participants. Outcomes provide preliminary evidence for the therapeutic potential of rTMS in SE-AN. Largest effects were observed on variables assessing mood. This study supports the need for a larger confirmatory trial to evaluate the effectiveness of multi-session rTMS in SE-AN. Future studies should include a longer follow-up period and an assessment of cost-effectiveness. TRIAL REGISTRATION NUMBER ISRCTN14329415; Pre-results.
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Affiliation(s)
- Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Jessica McClelland
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Maria Kekic
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Samantha J Rennalls
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Jessica Werthmann
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Owen G O’Daly
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Danielle Glennon
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nikola Kern
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
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Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co-occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018; 4:CD008581. [PMID: 29688573 PMCID: PMC6494437 DOI: 10.1002/14651858.cd008581.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alcohol dependence is a major public health problem characterized by recidivism, and medical and psychosocial complications. The co-occurrence of major depression in people entering treatment for alcohol dependence is common, and represents a risk factor for morbidity and mortality, which negatively influences treatment outcomes. OBJECTIVES To assess the benefits and risks of antidepressants for the treatment of people with co-occurring depression and alcohol dependence. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to July 2017. We also searched for ongoing and unpublished studies via ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/).All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA Randomized controlled trials and controlled clinical trials comparing antidepressants alone or in association with other drugs or psychosocial interventions (or both) versus placebo, no treatment, and other pharmacological or psychosocial interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included 33 studies in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.Comparing antidepressants to placebo, low-quality evidence suggested that antidepressants reduced the severity of depression evaluated with interviewer-rated scales at the end of trial (14 studies, 1074 participants, standardized mean difference (SMD) -0.27, 95% confidence interval (CI) -0.49 to -0.04). However, the difference became non-significant after the exclusion of studies with a high risk of bias (SMD -0.17, 95% CI -0.39 to 0.04). In addition, very low-quality evidence supported the efficacy of antidepressants in increasing the response to the treatment (10 studies, 805 participants, risk ratio (RR) 1.40, 95% Cl 1.08 to 1.82). This result became non-significant after the exclusion of studies at high risk of bias (RR 1.27, 95% CI 0.96 to 1.68). There was no difference for other relevant outcomes such as the difference between baseline and final score, evaluated using interviewer-rated scales (5 studies, 447 participants, SMD 0.15, 95% CI -0.12 to 0.42).Moderate-quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95% Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) -1.13 drinks per drinking days, 95% Cl -1.79 to -0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95% CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD -1.21 number of drinks per drinking days, 95% CI -1.91 to -0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95% Cl -1.66 to 4.34; low-quality evidence).Low-quality evidence suggested no differences between antidepressants and placebo in the number of dropouts (17 studies, 1159 participants, RR 0.98, 95% Cl 0.79 to 1.22) and adverse events as withdrawal for medical reasons (10 studies, 947 participants, RR 1.15, 95% Cl 0.65 to 2.04).There were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative. AUTHORS' CONCLUSIONS We found low-quality evidence supporting the clinical use of antidepressants in the treatment of people with co-occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co-occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co-occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest.
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Affiliation(s)
- Roberta Agabio
- University of CagliariDepartment of Biomedical Sciences, Section of Neuroscience and Clinical PharmacologyCagliariItaly
| | - Emanuela Trogu
- Cagliari Public Health TrustDepartment of PsychiatryASL CagliariCagliariSardiniaItaly09128
| | - Pier Paolo Pani
- Sardinia Protection Health TrustSassari Social‐Health AreaSassariSardiniaItaly
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Rachid F. Maintenance repetitive transcranial magnetic stimulation (rTMS) for relapse prevention in with depression: A review. Psychiatry Res 2018; 262:363-372. [PMID: 28951141 DOI: 10.1016/j.psychres.2017.09.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/24/2017] [Accepted: 09/07/2017] [Indexed: 01/29/2023]
Abstract
Major depressive disorder is a highly prevalent condition with significant morbidity and mortality. Recurrent episodes occur in greater than 50% of patients within a one year period despite treatment with antidepressant medications, electroconvulsive therapy and psychotherapy. Longer antidepressant treatment may prevent relapses and recurrences. Urgent therapeutic alternatives are needed such as maintenance repetitive transcranial magnetic stimulation. The purpose of this review is to describe and discuss studies that have evaluated the safety and efficacy of this technique in the long-term treatment and relapse prevention of depression. The electronic literature on maintenance repetitive transcranial magnetic stimulation for depression was reviewed. A limited number of controlled, open-label studies as well as case series have been published on maintenance rTMS after successful response to acute rTMS. In the majority of these studies, most patients with treatment-resistant unipolar or bipolar depression with or without medications experienced either moderate or marked benefit with maintenance rTMS, sometimes remission for three months and up to eight years. Many of the reviewed studies have shown promising results, however, future well-designed sham-controlled studies are needed to confirm the long-term safety and efficacy of maintenance rTMS in the relapse prevention of depression.
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Affiliation(s)
- Fady Rachid
- Private practice, 7, place de la Fusterie, 1204 Geneva, Switzeland.
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Bridges NR, McKinley RA, Boeke D, Sherwood MS, Parker JG, McIntire LK, Nelson JM, Fletchall C, Alexander N, McConnell A, Goodyear C, Nelson JT. Single Session Low Frequency Left Dorsolateral Prefrontal Transcranial Magnetic Stimulation Changes Neurometabolite Relationships in Healthy Humans. Front Hum Neurosci 2018; 12:77. [PMID: 29632477 PMCID: PMC5879132 DOI: 10.3389/fnhum.2018.00077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Dorsolateral prefrontal cortex (DLPFC) low frequency repetitive transcranial magnetic stimulation (LF-rTMS) has shown promise as a treatment and investigative tool in the medical and research communities. Researchers have made significant progress elucidating DLPFC LF-rTMS effects—primarily in individuals with psychiatric disorders. However, more efforts investigating underlying molecular changes and establishing links to functional and behavioral outcomes in healthy humans are needed. Objective: We aimed to quantify neuromolecular changes and relate these to functional changes following a single session of DLPFC LF-rTMS in healthy participants. Methods: Eleven participants received sham-controlled neuronavigated 1 Hz rTMS to the region most activated by a 7-letter Sternberg working memory task (SWMT) within the left DLPFC. We quantified SWMT performance, functional magnetic resonance activation and proton Magnetic resonance spectroscopy (MRS) neurometabolite measure changes before and after stimulation. Results: A single LF-rTMS session was not sufficient to change DLPFC neurometabolite levels and these changes did not correlate with DLPFC activation changes. Real rTMS, however, significantly altered neurometabolite correlations (compared to sham rTMS), both with baseline levels and between the metabolites themselves. Additionally, real rTMS was associated with diminished reaction time (RT) performance improvements and increased activation within the motor, somatosensory and lateral occipital cortices. Conclusion: These results show that a single session of LF-rTMS is sufficient to influence metabolite relationships and causes widespread activation in healthy humans. Investigating correlational relationships may provide insight into mechanisms underlying LF-rTMS.
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Affiliation(s)
| | - Richard A McKinley
- Warfighter Interfaces Division, Applied Neuroscience Branch, Wright-Patterson AFB (WPAFB), Dayton, OH, United States
| | - Danielle Boeke
- Warfighter Interfaces Division, Applied Neuroscience Branch, Wright-Patterson AFB (WPAFB), Dayton, OH, United States
| | - Matthew S Sherwood
- Wright State Research Institute, Wright State University, Dayton, OH, United States
| | - Jason G Parker
- Kettering Health Network Innovation Center, Kettering, OH, United States
| | | | | | - Catherine Fletchall
- Grandview Medical Center, Kettering Health Network, Dayton, OH, United States
| | - Natasha Alexander
- Grandview Medical Center, Kettering Health Network, Dayton, OH, United States
| | - Amanda McConnell
- Grandview Medical Center, Kettering Health Network, Dayton, OH, United States
| | | | - Jeremy T Nelson
- Research Imaging Institute, School of Medicine, University of Texas Health Science Center, San Antonio, San Antonio, TX, United States
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Haesebaert F, Moirand R, Schott-Pethelaz AM, Brunelin J, Poulet E. Usefulness of repetitive transcranial magnetic stimulation as a maintenance treatment in patients with major depression. World J Biol Psychiatry 2018; 19:74-78. [PMID: 27807990 DOI: 10.1080/15622975.2016.1255353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To investigate the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS), venlafaxine or a combination of both treatments as a maintenance treatment in patients with treatment-resistant depression (TRD). METHODS In a three-arm open-label study, 66 patients, including 45 remitters, who responded to rTMS (n = 25), venlafaxine (n = 22), or a combination of both treatments (n = 19) continued to receive the treatment that led to a response as a maintenance treatment over 12 months. Maintenance rTMS was administered twice per week for 1 month, once per week for 2 months, and once every 2 weeks for 9 months. Venlafaxine was maintained at the dose that induced a clinical response (150 or 225 mg/day). RESULTS After the 12-month follow-up, the rates of remitters (HDRS < 8) were not different between the three groups (χ2 = 1.25; P = .3). The rates of patients who not relapsed (HDRS < 15) were not different between groups (χ2 = 0.33; P = .8): 40.0% in the rTMS group, 45.1% in the venlafaxine group and 36.9% in the combination group. CONCLUSIONS The three maintenance approaches exhibited similar efficacies in relapse prevention and the maintenance of remission in patients with TRD.
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Affiliation(s)
- Frédéric Haesebaert
- a INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ΨR2 Team , University Lyon , France.,b Centre Hospitalier Le Vinatier , Bron , France
| | - Rémi Moirand
- a INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ΨR2 Team , University Lyon , France.,b Centre Hospitalier Le Vinatier , Bron , France
| | | | - Jérôme Brunelin
- a INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ΨR2 Team , University Lyon , France.,b Centre Hospitalier Le Vinatier , Bron , France
| | - Emmanuel Poulet
- a INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ΨR2 Team , University Lyon , France.,b Centre Hospitalier Le Vinatier , Bron , France.,d Service de Psychiatrie des urgences , CHU Lyon, Hôpital Edouard Herriot , Lyon , France
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Feffer K, Fettes P, Giacobbe P, Daskalakis ZJ, Blumberger DM, Downar J. 1Hz rTMS of the right orbitofrontal cortex for major depression: Safety, tolerability and clinical outcomes. Eur Neuropsychopharmacol 2018; 28:109-117. [PMID: 29153927 DOI: 10.1016/j.euroneuro.2017.11.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/12/2017] [Accepted: 11/04/2017] [Indexed: 12/28/2022]
Abstract
Conventional rTMS in major depressive disorder (MDD) targets the dorsolateral prefrontal cortex (DLPFC). However, many patients do not respond to DLPFC-rTMS. Recent evidence suggests that the right lateral orbitofrontal cortex (OFC) plays a key role in 'non-reward' functions and shows hyperconnectivity in MDD. OFC-rTMS has been used successfully in obsessive-compulsive disorder, and achieved remission in an MDD case nonresponsive to DLPFC- and DMPFC-rTMS. Here, we assess the safety and tolerability of right OFC-rTMS, and examine the effectiveness of inhibitory right OFC-rTMS in MDD, particularly among patients with previous nonresponse to DMPFC-rTMS. We performed a chart review to retrieve data on clinical characteristics, stimulation parameters, adverse events, and clinical symptom outcomes for a series of 42 patients with medication-resistant and/or DMPFC-rTMS-nonresponsive MDD, who underwent 20-30 sessions of 1Hz right OFC-rTMS at a single Canadian clinic from 2015 to 2017. Over 882 sessions of treatment, there were no seizures, visual/ocular complications, or other serious or treatment-limiting adverse events. Pain ratings averaged 6-7/10 (10=maximum tolerable); no patient discontinued treatment prematurely due to pain. 15/42 patients (35.7%) achieved response (≥50% symptom reduction) and 10/42 (23.8%) achieved remission. Among the 30/42 patients who were previous nonresponders to DMPFC-rTMS, 9/30 (30.0%) achieved response and 7/30 (23.8%) achieved remission. Response distribution was sharply bimodal. 1Hz right OFC-rTMS appears safe and tolerable, and may achieve remission in MDD patients even when conventional rTMS has failed. Sham-controlled follow-up studies may be warranted.
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Affiliation(s)
- Kfir Feffer
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Shalvata Mental Health Center, Hod-Hasharon, Israel
| | - Peter Fettes
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter Giacobbe
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jonathan Downar
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada.
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Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression. Brain Stimul 2018; 11:181-189. [DOI: 10.1016/j.brs.2017.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/27/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
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Dalton B, Bartholdy S, Campbell IC, Schmidt U. Neurostimulation in Clinical and Sub-clinical Eating Disorders: A Systematic Update of the Literature. Curr Neuropharmacol 2018; 16:1174-1192. [PMID: 29308739 PMCID: PMC6187753 DOI: 10.2174/1570159x16666180108111532] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/17/2017] [Accepted: 01/04/2017] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Whilst psychological therapies are the main approach to treatment of eating disorders (EDs), advances in aetiological research suggest the need for the development of more targeted, brain-focused treatments. A range of neurostimulation approaches, most prominently repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and deep brain stimulation (DBS), are rapidly emerging as potential novel interventions. We have previously reviewed these techniques as potential treatments of EDs. AIM To provide an update of the literature examining the effects of DBS, rTMS and tDCS on eating behaviours, body weight and associated symptoms in people with EDs and relevant analogue populations. METHODS Using PRISMA guidelines, we reviewed articles in PubMed, Web of Science, and PsycINFO from 1st January 2013 until 14th August 2017, to update our earlier search. Studies assessing the effects of neurostimulation techniques on eating and weight-related outcomes in people with EDs and relevant analogue populations were included. Data from both searches were combined. RESULTS We included a total of 32 studies (526 participants); of these, 18 were newly identified by our update search. Whilst findings are somewhat mixed for bulimia nervosa, neurostimulation techniques have shown potential in the treatment of other EDs, in terms of reduction of ED and associated symptoms. Studies exploring cognitive, neural, and hormonal correlates of these techniques are also beginning to appear. CONCLUSIONS Neurostimulation approaches show promise as treatments for EDs. As yet, large wellconducted randomised controlled trials are lacking. More information is needed about treatment targets, stimulation parameters and mechanisms of action.
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Affiliation(s)
- Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, King`s College London, London, United Kingdom
| | - Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, King`s College London, London, United Kingdom
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, King`s College London, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, King`s College London, London, United Kingdom
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Guo Q, Li C, Wang J. Updated Review on the Clinical Use of Repetitive Transcranial Magnetic Stimulation in Psychiatric Disorders. Neurosci Bull 2017; 33:747-756. [PMID: 29064064 DOI: 10.1007/s12264-017-0185-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/02/2017] [Indexed: 12/28/2022] Open
Abstract
With the ability to modulate cortical activity, repetitive transcranial magnetic stimulation (rTMS) is becoming increasingly important in clinical applications for psychiatric disorders. Previous studies have demonstrated its promising efficacy in depression and schizophrenia, and emerging evidence has also been found in patients with anxiety disorder, obsessive-compulsive disorder, and substance or food craving. However, the overall literature features some conflicting results, varied quality of studies, and a lack of consensus on optimal rTMS parameters. Besides, the efficacy of rTMS in patients with medication-resistant symptoms has drawn most attention from clinicians. Here we review multi-site studies and double-blind randomized controlled trials (RCTs) in single sites, as well as meta-analyses of RCTs in the last three years, in order to update evidence on efficacy and the optimal protocol of rTMS in psychiatric disorders, especially for medication-resistant symptoms.
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Affiliation(s)
- Qian Guo
- Shanghai Key Laboratory of Psychotic Disorders (No. 13dz2260500), Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders (No. 13dz2260500), Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200030, China.,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders (No. 13dz2260500), Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai Jiao Tong University, Shanghai, 200030, China. .,Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, 200030, China.
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Repetitive transcranial magnetic stimulation inhibits Sirt1/MAO-A signaling in the prefrontal cortex in a rat model of depression and cortex-derived astrocytes. Mol Cell Biochem 2017; 442:59-72. [PMID: 28948423 DOI: 10.1007/s11010-017-3193-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/09/2017] [Indexed: 02/06/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a useful monotherapy for depression or adjunctive therapy for resistant depression. However, the anti-depressive effects of different parameters and the underlying mechanisms remain unclear. Here, we aimed to assess the effect of rTMS with different parameters (1/5/10 Hz, 0.84/1.26 T) on the depressive-like behaviors, 5-hydroxytryptamine (5-HT), 5-HIAA (5-hydroxyindoleacetic acid) and DA and NE levels, and monoamine oxidase A (MAO-A) activity in chronic unpredictable stress-treated rats, along with the expression of sirtuin 1 (Sirt1) and MAO-A in the prefrontal cortex (PFC) and cortex-derived astrocytes from new-born rats. Moreover, the depressive-like behaviors were monitored following the transcranial injection of the Sirt1 inhibitor EX527 (1 mM) daily for 1 week. We found that rTMS treatment (5/10 Hz, 0.84/1.26 T) ameliorated depressive-like behaviors, increased 5-HT, DA and NE levels, decreased the 5-HIAA level and Sirt1 and MAO-A expression, and reduced MAO-A activity in the PFC. The depressive-like behaviors were also ameliorated after the transcranial injection of EX527. Importantly, rTMS (5/10 Hz, 0.84/1.26 T) inhibited Sirt1 and MAO-A expressions in astrocytes and Sirt1 knockdown with short hairpin RNA decreased MAO-A expression in astrocytes. These results suggest that the inhibition of Sirt1/MAO-A expression in astrocytes in the PFC may contribute to the different anti-depressive effects of rTMS with different parameters, and may also provide a novel insight into the mechanisms underlying major depressive disorder.
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Thibaut A, O'Brien AT, Fregni F. Strategies for replacing non-invasive brain stimulation sessions: recommendations for designing neurostimulation clinical trials. Expert Rev Med Devices 2017; 14:633-649. [PMID: 28681660 DOI: 10.1080/17434440.2017.1352470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Despite the potential impact of missed visits on the outcomes of neuromodulation treatments, it is not clear how this issue has been addressed in clinical trials. Given this gap in the literature, we reviewed articles on non-invasive brain stimulation in participants with depression or chronic pain, and investigated how missed visits were handled. Areas covered: We performed a search on PUBMED/MEDLINE using the keywords: 'tDCS', 'transcranial direct current stimulation', 'transcranial magnetic stimulation', 'depression', and 'pain'. We included studies with a minimum of five participants who were diagnosed with depression or chronic pain, who underwent a minimum of five tDCS or TMS sessions. A total of 181 studies matched our inclusion criteria, 112 on depression and 69 on chronic pain. Of these, only fifteen (8%) articles reported or had a protocol addressing missed visits. This review demonstrates that, in most of the trials, there is no reported plan to handle missed visits. Expert commentary: Based on our findings and previous studies, we developed suggestions on how to handle missed visits in neuromodulation protocols. A maximum of 20% of missing sessions should be allowed before excluding a patient and these sessions should be replaced at the end of the stimulation period.
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Affiliation(s)
- Aurore Thibaut
- a Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA
| | - Anthony Terrence O'Brien
- a Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA
| | - Felipe Fregni
- a Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA
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Gay A, Boutet C, Sigaud T, Kamgoue A, Sevos J, Brunelin J, Massoubre C. A single session of repetitive transcranial magnetic stimulation of the prefrontal cortex reduces cue-induced craving in patients with gambling disorder. Eur Psychiatry 2017; 41:68-74. [PMID: 28049084 DOI: 10.1016/j.eurpsy.2016.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/30/2016] [Accepted: 11/02/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gambling disorder (GD) is common and disabling addictive disorder. In patients with substance use disorders, the application of repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) offers promise to alleviate craving. We hypothesized that applying real compared to sham rTMS over the left DLPFC would reduce gambling craving in patients with GD. METHODS In a randomized sham-controlled crossover design, 22 treatment-seeking patients with GD received real or sham treatment with high frequency rTMS over the left DLPFC followed a week later by the other type of treatment. Before and after each rTMS session, participants rated their gambling craving (from 0 to 100) before and after viewing a gambling video used as a cue. We used the Yale-Brown Obsessive Compulsive Scale adapted for Pathological Gambling to assess gambling behavior before and 7 days after each rTMS session. RESULTS As compared to sham (mean +0.74; standard deviation±3.03), real rTMS significantly decreased cue-induced craving (-2.12±3.39; F(1,19)=4.87; P=0.04; partial η2=0.05; 95% CI: 0.00-0.21). No significant effect of rTMS was observed on gambling behavior. CONCLUSIONS Patients with GD reported decreased cue-induced craving following a single session of high frequency rTMS applied over the left DLPFC. Further large randomized controlled studies are needed to determine the usefulness of rTMS in GD.
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Affiliation(s)
- A Gay
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France; TAPE laboratory, EA7423, Jean-Monnet university, Saint-Étienne, France.
| | - C Boutet
- INSERM, U1059, university of Lyon, 42023 Saint-Étienne, France; Radiology department, university hospital center of Saint-Étienne, 42055 Saint-Étienne, France
| | - T Sigaud
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France; TAPE laboratory, EA7423, Jean-Monnet university, Saint-Étienne, France
| | - A Kamgoue
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France
| | - J Sevos
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France; TAPE laboratory, EA7423, Jean-Monnet university, Saint-Étienne, France
| | - J Brunelin
- INSERM, U1028, CNRS, UMR5292, Lyon neuroscience research center, university of Lyon, ΨR2 Team, 69000 Lyon, France; Lyon 1 university, 69000 Villeurbanne, France; Hospital center Le Vinatier, 69678 Bron, France
| | - C Massoubre
- University hospital center of Saint-Étienne, university department of psychiatry and addiction, 42055 Saint-Étienne, France; TAPE laboratory, EA7423, Jean-Monnet university, Saint-Étienne, France
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Deschamps T, Sauvaget A, Pichot A, Valrivière P, Maroulidès M, Bois A, Bulteau S, Thomas-Ollivier V. Posture-cognitive dual-tasking: A relevant marker of depression-related psychomotor retardation. An illustration of the positive impact of repetitive transcranial magnetic stimulation in patients with major depressive disorder. J Psychiatr Res 2016; 83:86-93. [PMID: 27580486 DOI: 10.1016/j.jpsychires.2016.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 12/28/2022]
Abstract
This study examined whether postural control variables, particularly the center-of-pressure (COP) velocity-based parameters, could be a relevant hallmark of depression-related psychomotor retardation (PMR). We first aimed at investigating the interplay between the PMR scores and the COP performance in patients with major depressive disorder (MDD), as compared to age-matched healthy controls; secondly, we focused on the impact of a repetitive transcranial magnetic stimulation (rTMS) treatment on depression, PMR scores and postural performance. 16 MDD patients, and a control group of 16 healthy adults, were asked to maintain quiet standing balance during two trials with or without vision, and while backward counting (dual task). All the position and velocity-based COP variables were computed. Before and after the rTMS session (n eligible MDD = 10), we assessed the depression level with the Montgomery-Asberg Depression Rating Scale (MADRS), the PMR scores with the French Retardation Rating Scale for Depression (ERD), and postural performance. Before the treatment, significant positive partial correlations were found between the pre-ERD scores and the velocity-based COP variables, especially in the dual-task conditions (p < 0.05). In contrast, there was no significant correlation between the post-ERD scores and any postural parameter after the treatment. The MADRS and ERD scores showed a significant decrease between before and after the rTMS intervention. For the first time, the findings clearly validated the view that the assessment of postural performance - easy to envisage in clinical settings-constitutes a reliable and objective marker of PMR in MDD patients.
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Affiliation(s)
- Thibault Deschamps
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France.
| | - Anne Sauvaget
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France; EA SPHERE 4275 Methods for Patients-centered outcomes and Health Research, University of Nantes, Nantes, France
| | - Anne Pichot
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
| | - Pierre Valrivière
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
| | - Maxime Maroulidès
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France
| | - Aurore Bois
- Laboratory "Movement, Interactions, Performance" (E.A. 4334), University of Nantes, France
| | - Samuel Bulteau
- CHU de Nantes, Service d'Addictologie et Psychiatrie de liaison, France
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Fettes P, Peters S, Giacobbe P, Blumberger DM, Downar J. Neural correlates of successful orbitofrontal 1 Hz rTMS following unsuccessful dorsolateral and dorsomedial prefrontal rTMS in major depression: A case report. Brain Stimul 2016; 10:165-167. [PMID: 28017321 DOI: 10.1016/j.brs.2016.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 11/13/2016] [Indexed: 01/13/2023] Open
Affiliation(s)
- Peter Fettes
- Institute of Medical Science, University of Toronto, Canada
| | - Sarah Peters
- Institute of Medical Science, University of Toronto, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Canada; MRI-Guided rTMS Clinic, Centre for Mental Health, University Health Network, Toronto, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jonathan Downar
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; MRI-Guided rTMS Clinic, Centre for Mental Health, University Health Network, Toronto, Canada; Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Canada.
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Hesselberg ML, Wegener G, Buchholtz PE. Antidepressant efficacy of high and low frequency transcranial magnetic stimulation in the FSL/FRL genetic rat model of depression. Behav Brain Res 2016; 314:45-51. [DOI: 10.1016/j.bbr.2016.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/17/2016] [Accepted: 07/20/2016] [Indexed: 02/06/2023]
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Poulet E, Galvao F, Haffen E, Szekely D, Brault C, Haesebaert F, Brunelin J. Effects of smoking status and MADRS retardation factor on response to low frequency repetitive transcranial magnetic stimulation for depression. Eur Psychiatry 2016; 38:40-44. [PMID: 27657664 DOI: 10.1016/j.eurpsy.2016.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Despite growing evidence supporting the clinical interest of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD), little is known regarding the effects of clinical and sociodemographic factors on the clinical outcome in patients. METHODS We retrospectively investigated the effects of clinical (using the 3-factor model of the Montgomery-Åsberg depression rating scale [MADRS] encompassing dysphoria, retardation and vegetative symptoms) and sociodemographic characteristics of participants on clinical outcome in a sample of 54 TRD patients receiving low frequency rTMS (1Hz, 360 pulses) applied over the right dorsolateral prefrontal cortex combined with sham venlafaxine. RESULTS Responders (n=29) displayed lower retardation baseline scores (13.6±2.9) than non-responders (15.6±2.9; n=25; P=0.02). We also observed a significant difference between the numbers of ex-smokers in responders and non-responders groups; all ex-smokers (n=8) were responders to rTMS (P=0.005). CONCLUSION Low MADRS retardation factor and ex-smoker status is highly prevalent in responders to low frequency rTMS. Further studies are needed to investigate the predictive value of these factors.
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Affiliation(s)
- E Poulet
- Inserm, U1028, CNRS, UMR5292, Lyon neuroscience research center, ΨR2 Team, université de Lyon, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Centre hospitalier Le Vinatier, 69678 Bron, France; Service de psychiatrie des urgences, hôpital Édouard-Herriot, CHU de Lyon, 69000 Lyon, France.
| | - F Galvao
- Inserm, U1028, CNRS, UMR5292, Lyon neuroscience research center, ΨR2 Team, université de Lyon, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Centre hospitalier Le Vinatier, 69678 Bron, France
| | - E Haffen
- Department of clinical psychiatry, CIC-1431 Inserm, university hospital of Besançon, 25000 Besançon, France; EA-481, université Bourgogne Franche-Comté, université Franche-Comté, 25000 Besançon, France; FondaMental foundation, 94000 Créteil, France
| | - D Szekely
- Princess Grace hospital, department of psychiatry, 98012 Monaco, France
| | - C Brault
- Pôle « information médicale évaluation recherche » (IMER), CHU de Lyon, 62, avenue Lacassagne, bâtiment A, 69424 Lyon cedex 03, France
| | - F Haesebaert
- Inserm, U1028, CNRS, UMR5292, Lyon neuroscience research center, ΨR2 Team, université de Lyon, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Centre hospitalier Le Vinatier, 69678 Bron, France
| | - J Brunelin
- Inserm, U1028, CNRS, UMR5292, Lyon neuroscience research center, ΨR2 Team, université de Lyon, 69000 Lyon, France; University Lyon 1, 69000 Villeurbanne, France; Centre hospitalier Le Vinatier, 69678 Bron, France
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Abstract
Only one third of patients suffering from depression will achieve a satisfactory response with first line treatments and more than half of patients will fail to obtain at least 50 % reduction in their symptoms after 3 months of treatment. This article presents a review of the scientific arguments supporting the various therapeutic strategies when confronted to a first treatment failure after an adequate drug trial. Several pharmacological approaches are possible. A first and classical approach is adjusting the drug dosage (optimization). This strategy is coherent with the pharmacological profile of some antidepressant drugs (tricyclic antidepressants, tetracyclic antidepressants, venlafaxine). There is no scientific basis to a dose-effect relationship with the selective serotonin reuptake inhibitors (SSRIs), as minimal doses of these drugs correspond to a high ratio of serotonin transporter occupation; however increasing doses of SSRIs constitutes a usual practice, endorsed by several experts. A second classic strategy is changing an inefficient antidepressant drug to another antidepressant drug (switch). Theoretically, a different pharmacological class should have more chances to be successful; however, in the case of a failure with an SSRI, an inter-class switch has not consistently proven to be superior to an intra-class switch. In some cases, association of antidepressant drugs can also be an advantageous strategy (combination), particularly in the case of partial response with the first prescribed drug. Due to its particular mechanism of action, mirtazapine is often a drug of choice in the case of such an association. Finally, another approach to recommend in case of partial response is associating an antidepressant drug to another class of drugs, such as lithium, atypical antipsychotics or thyroid hormones (potentiation). Lithium has unfailingly proven its efficacy in case of resistance, but the utilization of atypical antipsychotics, at low-doses, has become increasingly common, certainly, because they are easier to handle. Aside from the pharmacological options, we can consider a number of other strategies, first among them is psychotherapy. Most studies assessing the efficacy of psychotherapy were conducted with this therapy as a first-line treatment. More studies of psychotherapy in depression after unsatisfactory response are distinctly needed. Available data seem to indicate that psychotherapy constitutes an efficient alternative, regardless of the type of psychotherapy (results are more robust in cognitive and behavioural therapies and brief interpersonal psychotherapy, in relation with the greater number of studies using these therapies), with effect sizes comparable to the ones obtained with pharmacological options. Among other strategies, physical exercise has been getting more attention lately, even though evidence in this indication remains deceiving for the moment. Lastly, neuromodulation techniques have an unquestionable place. The rTMS has been largely tested with interesting results. Given the time and staff necessary to conduct this therapy, the question has now switched to how precisely select the patients who will most benefit from rTMs, and how long and at what pace should the sessions take place. ECT is undoubtedly the most efficient treatment, but, apart from life-threatening melancholia and other restricted exceptions, it is usually indicated in multi-resistant depression. Some authors suggest using this therapy earlier, as chronicity of the disease is itself a factor of poor response. Finally, this article reviews also the most recent French and International guidelines in managing patients having showed an unsatisfactory response to a first-line treatment.
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Dunlop K, Hanlon CA, Downar J. Noninvasive brain stimulation treatments for addiction and major depression. Ann N Y Acad Sci 2016; 1394:31-54. [PMID: 26849183 PMCID: PMC5434820 DOI: 10.1111/nyas.12985] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Major depressive disorder (MDD) and substance use disorders (SUDs) are prevalent, disabling, and challenging illnesses for which new treatment options are needed, particularly in comorbid cases. Neuroimaging studies of the functional architecture of the brain suggest common neural substrates underlying MDD and SUDs. Intrinsic brain activity is organized into a set of functional networks, of which two are particularly relevant to psychiatry. The salience network (SN) is crucial for cognitive control and response inhibition, and deficits in SN function are implicated across a wide variety of psychiatric disorders, including MDD and SUDs. The ventromedial network (VMN) corresponds to the classic reward circuit, and pathological VMN activity for drug cues/negative stimuli is seen in SUDs/MDD. Noninvasive brain stimulation (NIBS) techniques, including rTMS and tDCS, have been used to enhance cortico–striatal–thalamic activity through the core SN nodes in the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, and anterior insula. Improvements in both MDD and SUD symptoms ensue, including in comorbid cases, via enhanced cognitive control. Inhibition of the VMN also appears promising in preclinical studies for quenching the pathological incentive salience underlying SUDs and MDD. Evolving techniques may further enhance the efficacy of NIBS for MDD and SUD cases that are unresponsive to conventional treatments.
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Affiliation(s)
- Katharine Dunlop
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Colleen A Hanlon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan Downar
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
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Towards new mechanisms: an update on therapeutics for treatment-resistant major depressive disorder. Mol Psychiatry 2015; 20:1142-50. [PMID: 26148812 DOI: 10.1038/mp.2015.92] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/24/2015] [Accepted: 06/01/2015] [Indexed: 02/07/2023]
Abstract
Depression is a devastating disorder that places a significant burden on both the individual and society. As such, the discovery of novel therapeutics and innovative treatments--especially for treatment-resistant depression (TRD)--are essential. Research into antidepressant therapies for TRD has evolved from explorations of antidepressants with primary mechanisms of action on the monoaminergic neurotransmitter system to augmentation agents with primary mechanisms both within and outside of the serotonin/norepinephrine system. Now the field of antidepressant research has changed trajectories yet again; this time, compounds with primary mechanisms of action on the glutamatergic, cholinergic and opioid systems are in the forefront of antidepressant exploration. In this review, we will discuss the most recent research surrounding these novel compounds. In addition, we will discuss novel device-based therapeutics, with a particular focus on transcranial magnetic stimulation. In many cases of antidepressant drug discovery, the role of serendipity coupled with meticulous clinical observation in drug development in medicine was crucial. Moving forward, we must look toward the combination of innovation plus improvements on the remarkable discoveries thus far to advance the field of antidepressant research.
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Low-frequency repetitive transcranial magnetic stimulation (rTMS), a new treatment option in neuropsychiatry. Acta Neuropsychiatr 2015; 27:248-9. [PMID: 26138220 DOI: 10.1017/neu.2015.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Repetitive transcranial magnetic stimulation can alleviate treatment-resistant depression in patients with progressive supranuclear palsy. Parkinsonism Relat Disord 2015; 21:1113-4. [PMID: 26182830 DOI: 10.1016/j.parkreldis.2015.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/27/2015] [Accepted: 07/07/2015] [Indexed: 11/23/2022]
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Trojak B, Meille V, Achab S, Lalanne L, Poquet H, Ponavoy E, Blaise E, Bonin B, Chauvet-Gelinier JC. Transcranial Magnetic Stimulation Combined With Nicotine Replacement Therapy for Smoking Cessation: A Randomized Controlled Trial. Brain Stimul 2015; 8:1168-74. [PMID: 26590478 DOI: 10.1016/j.brs.2015.06.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/06/2015] [Accepted: 06/07/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Further evidence suggests that repetitive Transcranial Magnetic Stimulation (rTMS) is an effective method to reduce tobacco craving among smokers. HYPOTHESIS As relapse is common within a few days after smoking cessation, we hypothesized that combining the anti-craving effects of rTMS with Nicotine replacement therapy (NRT) to attenuate withdrawal symptoms could increase abstinence rates in smokers with severe nicotine dependence who quit smoking. METHODS Thirty-seven smokers who failed to quit with the usual treatments were randomly assigned to two treatment groups to receive either active (n = 18) or sham (n = 19) 1-Hz rTMS of the right dorsolateral prefrontal cortex. The day after quitting smoking, each patient combined NRT (21-mg patch) with active or sham rTMS (10 sessions) for 2 weeks. Cessation support was then continued with NRT alone using lower-dose patches. Abstinence rates and self-report craving scales were used to assess the therapeutic results during the combined treatment and for up to 12 weeks after quitting. RESULTS At the end of the combined treatment, there were significantly more abstinent participants in the active rTMS group (n = 16) than in the sham rTMS group (n = 9) (P = 0.027). The craving scales analysis revealed that active rTMS (P = 0.011) but not sham rTMS (P = 0.116) led to a significant decrease in the compulsive factor. However, no lasting rTMS effect was found. CONCLUSIONS 1-Hz rTMS combined with NRT improved the success rate of abstinence in smokers during tobacco cessation. The stimulation-induced reduction in compulsivity may explain this result.
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Affiliation(s)
- Benoit Trojak
- Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France; EA 4452, LPPM, University of Burgundy, 21000 Dijon, France.
| | - Vincent Meille
- Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France
| | - Sophia Achab
- Addiction Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 1202 Geneva, Switzerland
| | - Laurence Lalanne
- Department of Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; INSERM U 1114, FMTS, Strasbourg University Hospital, 67091 Strasbourg, France
| | - Hélène Poquet
- Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France
| | - Eddy Ponavoy
- Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France
| | - Emilie Blaise
- Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France
| | - Bernard Bonin
- Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France; EA 4452, LPPM, University of Burgundy, 21000 Dijon, France
| | - Jean-Christophe Chauvet-Gelinier
- Department of Psychiatry and Addictology, University Hospital of Dijon, 21079 Dijon, France; EA 4452, LPPM, University of Burgundy, 21000 Dijon, France
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Bennabi D, Aouizerate B, El-Hage W, Doumy O, Moliere F, Courtet P, Nieto I, Bellivier F, Bubrovsky M, Vaiva G, Holztmann J, Bougerol T, Richieri R, Lancon C, Camus V, Saba G, Haesbaert F, d'Amato T, Charpeaud T, Llorca PM, Leboyer M, Haffen E. Risk factors for treatment resistance in unipolar depression: a systematic review. J Affect Disord 2015; 171:137-41. [PMID: 25305428 DOI: 10.1016/j.jad.2014.09.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/14/2014] [Accepted: 09/18/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Treatment resistant depression is a complex disorder and an important source of morbidity and mortality. Identification of risk factors of resistance may be useful to improve early recognition as well as treatment selection and prediction of outcome in patients with depression. METHODS The aim of this paper was to review the current status of knowledge regarding risk factors of treatment resistance in unipolar depression, in patients who failed to respond to at least two successive and adequate antidepressant treatments. RESULTS Systematic literature search yielded 8 publications exploring clinical and biological factors. Specific psychiatric comorbidities, psychosocial factors, clinical characteristics of the depressive episode and biological markers emerge as possible risk factor for treatment resistant depression. LIMITATIONS Due to the lack of objective definition and diagnostic criteria for treatment resistant depression, and the paucity of reports on risk factors, our review only summarized a small number of studies. CONCLUSION Future investigations of risk factors should help to improve the understanding of the mechanisms underlying resistance in mood disorders and contribute to improve their therapeutic management.
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Affiliation(s)
- D Bennabi
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France.
| | - B Aouizerate
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - W El-Hage
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - O Doumy
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - F Moliere
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - P Courtet
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - I Nieto
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - F Bellivier
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - M Bubrovsky
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - G Vaiva
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - J Holztmann
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - T Bougerol
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - R Richieri
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - C Lancon
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - V Camus
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - G Saba
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - F Haesbaert
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - T d'Amato
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - T Charpeaud
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - P M Llorca
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - M Leboyer
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
| | - E Haffen
- Network of centres for Treatment-Resistant Depression, FondaMental Foundation, Créteil 94000, France
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Abstract
Major depression is often difficult to diagnose accurately. Even when the diagnosis is properly made, standard treatment approaches (eg, psychotherapy, medications, or their combination) are often inadequate to control acute symptoms or maintain initial benefit. Additional obstacles involve safety and tolerability problems, which frequently preclude an adequate course of treatment. This leaves an important gap in our ability to properly manage major depression in a substantial proportion of patients, leaving them vulnerable to ensuing complications (eg, employment-related disability, increased risk of suicide, comorbid medical disorders, and substance abuse). Thus, there is a need for more effective and better tolerated approaches. Transcranial magnetic stimulation is a neuromodulation technique increasingly used to partly fill this therapeutic void. In the context of treating depression, we critically review the development of transcranial magnetic stimulation, focusing on the results of controlled and pragmatic trials for depression, which consider its efficacy, safety, and tolerability.
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Affiliation(s)
- Philip G Janicak
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mehmet E Dokucu
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Brunelin J, Fecteau S. Can the effects of noninvasive brain stimulation alleviating neuropsychiatric symptoms result from a common beneficial regulation of the hypothalamic-pituitary-adrenal axis? Brain Stimul 2014; 8:173-6. [PMID: 25556003 DOI: 10.1016/j.brs.2014.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 11/21/2014] [Accepted: 11/29/2014] [Indexed: 12/27/2022] Open
Affiliation(s)
- Jerome Brunelin
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS) de l'Université Laval, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Québec, Canada; Faculté de médecine, Université Laval, 1050, Avenue de la Médecine, Quebec, Quebec, Canada G1V0A6; Centre Hospitalier le Vinatier, Université de Lyon, EA 4615, F-69003, France; Université Claude Bernard Lyon I, Bron, France.
| | - Shirley Fecteau
- Centre interdisciplinaire de recherche en réadaptation et en intégration sociale (CIRRIS) de l'Université Laval, Canada; Centre de recherche de l'Institut universitaire en santé mentale de Québec, Canada; Faculté de médecine, Université Laval, 1050, Avenue de la Médecine, Quebec, Quebec, Canada G1V0A6; Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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