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Rakesh G, Cordero P, Khanal R, Himelhoch SS, Rush CR. Optimally combining transcranial magnetic stimulation with antidepressants in major depressive disorder: A systematic review and Meta-analysis. J Affect Disord 2024; 358:432-439. [PMID: 38740269 DOI: 10.1016/j.jad.2024.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
There is a critical knowledge gap in optimally combining transcranial magnetic stimulation (TMS) and antidepressants to treat patients with major depressive disorder (MDD). TMS is effective in treating MDD in patients who have failed at least one antidepressant trial, with accelerated protocols showing faster remission in treatment-resistant depression (TRD). Although clinicians routinely augment antidepressants with TMS, there is a knowledge gap in stopping versus continuing antidepressants or the dosing strategies when starting or tapering TMS. These considerations are important when considering maintenance TMS (delivered alone or in combination with suitable antidepressants) to maintain remission in MDD after the index course of TMS. As the first step towards filling this knowledge gap, we reviewed randomized controlled trials (RCTs) and open-label trials from 2 databases (PubMed/Medline and EMBASE) that compared active TMS combined with a pre-specified antidepressant dosed in the same manner for adults with MDD versus sham TMS combined with the same antidepressant as in the active arm. All studies were published between January 1, 2000, and December 31, 2023. We excluded case reports, case series, and clinical studies that augmented TMS with antidepressants and vice versa. We found 10 RCTs (n = 654 participants) and performed a meta-analysis. This showed active TMS combined with pre-specified antidepressants had greater efficacy for MDD treatment than sham TMS combined with the same antidepressants as in the active arm (Hedge's g = 1; 95 % CI [0.27, 1.73]). The review and meta-analysis indicate greater short-term efficacy in combining antidepressants with TMS from the get-go in MDD. Given the increasing role of accelerated TMS protocols in expediting remission in MDD and the results of our meta-analysis, we advocate for RCTs examining the short-term and long-term effects of various antidepressant classes on these TMS protocols in MDD. This can also optimize and individualize maintenance TMS protocols to prevent relapse in MDD.
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Affiliation(s)
- Gopalkumar Rakesh
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States of America.
| | - Patrick Cordero
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Rebika Khanal
- University of Kentucky College of Medicine, Lexington, KY, United States of America
| | - Seth S Himelhoch
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Craig R Rush
- Department of Behavioral Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States of America
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Verma R, Ganesh R, Narnoli S, Nandakumar D, Sharma P, Sharma K, Dhyani I, Karna S. Effectiveness and tolerability of adjunctive transcranial direct current stimulation (tDCS) in management of treatment-resistant depression: A retrospective chart review. Indian J Psychiatry 2024; 66:538-544. [PMID: 39100375 PMCID: PMC11293779 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_243_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 08/06/2024] Open
Abstract
Background There is a limited number of studies from India investigating the role of transcranial direct current stimulation (tDCS) in treatment-resistant depression (TRD). This clinic-based study reports on the effectiveness of tDCS as an add-on treatment in individuals suffering from TRD. Materials and Methods Twenty-six right-handed individuals suffering from major depressive disorder who failed to respond to adequate trials of at least two antidepressant drugs in the current episode received tDCS as an augmenting treatment. Twice daily sessions of conventional tDCS were given providing anodal stimulation at the left dorsolateral prefrontal cortex (DLPFC) and cathodal placement at the right DLPFC. A total of 20 sessions were given over 2 weeks. The outcome was assessed based on changes in scores of the Hamilton Rating Scale for Depression (HAMD) and Montgomery-Asberg Depression Rating Scale (MADRS). Results There was a significant reduction in outcome assessment after tDCS intervention as compared to baseline, with more than 50% of the participants showing response in both scales, which increased further to approximately 77% by the end of 1 month of the follow-up period. Conclusion Twice daily tDCS sessions with anodal stimulation of left DLPFC and cathodal stimulation of right DLPFC is an effective add-on treatment strategy in individuals with TRD.
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Affiliation(s)
- Rohit Verma
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ragul Ganesh
- Department of Psychiatry, JIPMER, Puducherry, India
| | - Shubham Narnoli
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Panna Sharma
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Kuldeep Sharma
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ishita Dhyani
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Stuti Karna
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Jin Y, Li J, Xiao B. Efficacy and safety of neuromodulation for apathy in patients with Alzheimer's disease: A systematic review and meta-analysis of randomized controlled trials. J Psychiatr Res 2024; 171:17-24. [PMID: 38237255 DOI: 10.1016/j.jpsychires.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Non-pharmacological interventions, including noninvasive neuromodulation, may alleviate apathy in individuals with Alzheimer's disease. This systematic review and meta-analysis investigated the efficacy and safety of neuromodulation for apathy in elderly patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI). METHODS The Cochrane Central Register of Controlled Trials, EMBASE, and PubMed databases were searched for randomized controlled trials (RCTs) of neuromodulation for apathy in AD or MCI. The primary outcome was change in apathy based on the Apathy Evaluation Scale. Secondary outcomes were change in global cognition and trial discontinuation. RESULTS The meta-analysis included four RCTs involving 89 patients (aged 65.6-80.5 years) with apathy in AD or MCI. Findings showed no significant improvement in apathy (SMD = 0.57, 95% CI = -0.22-1.36; P = 0.16) or global cognition (SMD = 0.83, 95% CI = -0.11-1.78; P = 0.08) with neuromodulation compared to sham. Subgroup analyses showed significant improvement in apathy with high-frequency rTMS at 120% RMT compared to sham (SMD = 1.36, [95% CI = 0.61-2.12]; P = 0.0004), but not with rTMS at 80% RMT. For global cognition, high-frequency rTMS resulted in significant enhancement (SMD = 1.34 [95% CI = 0.59-2.10]; P = 0.0005), but no notable difference was observed with tDCS compared to sham. There was no significant difference in trial discontinuation in patients with AD or MCI treated with neuromodulation compared to sham. CONCLUSION High-frequency rTMS at 120% RMT for four weeks may be efficacious and safe for the treatment of apathy in elderly patients with AD or MCI. High-frequency rTMS may also improve global cognition in these patients. This implies rTMS has potential as an intervention for apathy in AD and MCI. Large well conducted RCTs are warranted to explore this effect further.
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Affiliation(s)
- Yushan Jin
- The First Affiliated Hospital of Shantou University Medical College, No. 57 Chang Ping Road, Shantou, 515041, Guangdong, PR China
| | - Jinbiao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No. 58 Zhong Shan Road 2, Guangzhou, 510080, Guangdong, PR China
| | - Bo Xiao
- Shantou University Medical College-Faculty of Medicine of University of Manitoba Joint Laboratory of Biological Psychiatry, Mental Health Center of Shantou University, Shantou, Guangdong, PR China.
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Shi R, Wang Z, Yang D, Hu Y, Zhang Z, Lan D, Su Y, Wang Y. Short-term and long-term efficacy of accelerated transcranial magnetic stimulation for depression: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:109. [PMID: 38326789 PMCID: PMC10851556 DOI: 10.1186/s12888-024-05545-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND In recent years, accelerated transcranial magnetic stimulation (aTMS) has been developed, which has a shortened treatment period. The aim of this study was to evaluate the efficacy and long-term maintenance effects of aTMS in patients with major depressive disorder (MDD). METHODS We systematically searched online databases for aTMS studies in patients with MDD published before February 2023 and performed a meta-analysis on the extracted data. RESULTS Four randomized controlled trials (RCTs) and 10 before-and-after controlled studies were included. The findings showed that depression scores significantly decreased following the intervention (SMD = 1.80, 95% CI (1.31, 2.30), p < 0.00001). There was no significant difference in antidepressant effectiveness between aTMS and standard TMS (SMD = -0.67, 95% CI (-1.62, 0.27), p = 0.16). Depression scores at follow-up were lower than those directly after the intervention based on the depression rating scale (SMD = 0.22, 95% CI (0.06, 0.37), p = 0.006), suggesting a potential long-term maintenance effect of aTMS. Subgroup meta-analysis results indicated that different modes of aTMS may have diverse long-term effects. At the end of treatment with the accelerated repetitive transcranial magnetic stimulation (arTMS) mode, depressive symptoms may continue to improve (SMD = 0.29, 95% CI (0.10, 0.49), I2 = 22%, p = 0.003), while the accelerated intermittent theta burst stimulation (aiTBS) mode only maintains posttreatment effects (SMD = 0.01, 95% CI (-0.45, 0.47), I2 = 66%, p = 0.98). CONCLUSIONS Compared with standard TMS, aTMS can rapidly improve depressive symptoms, but there is no significant difference in efficacy. aTMS may also have long-term maintenance effects, but longer follow-up periods are needed to assess this possibility. TRIAL REGISTRATION This article is original and not under simultaneous consideration for publication. The study was registered on PROSPERO ( https://www.crd.york.ac.uk/prospero/ ) (number: CRD42023406590).
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Affiliation(s)
- Ruifeng Shi
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Zuxing Wang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Dong Yang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Yujie Hu
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Zhongyang Zhang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Daotao Lan
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China
| | - Yihan Su
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China.
| | - Yunqiong Wang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China, No. 32, West 2nd Section, 1st Ring Road, 610031, Chengdu, Qingyang District, China.
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Kaneko N, Wada M, Nakajima S, Takano M, Taniguchi K, Honda S, Mimura M, Noda Y. Neuroplasticity of the left dorsolateral prefrontal cortex in patients with treatment-resistant depression as indexed with paired associative stimulation: a TMS-EEG study. Cereb Cortex 2024; 34:bhad515. [PMID: 38204301 PMCID: PMC10839839 DOI: 10.1093/cercor/bhad515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Major depressive disorder affects over 300 million people globally, with approximately 30% experiencing treatment-resistant depression (TRD). Given that impaired neuroplasticity underlies depression, the present study focused on neuroplasticity in the dorsolateral prefrontal cortex (DLPFC). Here, we aimed to investigate the differences in neuroplasticity between 60 individuals with TRD and 30 age- and sex-matched healthy controls (HCs). To induce neuroplasticity, participants underwent a paired associative stimulation (PAS) paradigm involving peripheral median nerve stimulation and transcranial magnetic stimulation (TMS) targeting the left DLPFC. Neuroplasticity was assessed by using measurements combining TMS with EEG before and after PAS. Both groups exhibited significant increases in the early component of TMS-evoked potentials (TEP) after PAS (P < 0.05, paired t-tests with the bootstrapping method). However, the HC group demonstrated a greater increase in TEPs than the TRD group (P = 0.045, paired t-tests). Additionally, event-related spectral perturbation analysis highlighted that the gamma power significantly increased after PAS in the HC group, whereas it was decreased in the TRD group (P < 0.05, paired t-tests with the bootstrapping method). This gamma power modulation revealed a significant group difference (P = 0.006, paired t-tests), indicating an inverse relationship for gamma power modulation. Our findings underscore the impaired neuroplasticity of the DLPFC in individuals with TRD.
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Affiliation(s)
- Naotsugu Kaneko
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, 3-8-1 Komaba, Meguro, Tokyo 153-8902, Japan
| | - Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Mayuko Takano
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
- Teijin Pharma Limited, 4-3-2 Asahigaoka, Hino, Tokyo 191-8512, Japan
| | - Keita Taniguchi
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Shiori Honda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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Breda V, Freire R. Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1456:145-159. [PMID: 39261428 DOI: 10.1007/978-981-97-4402-2_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Major depressive disorder (MDD) is a psychiatric disorder with several effective therapeutic approaches, being antidepressants and psychotherapies the first-line treatments. Nonetheless, due to side effects, limited efficacy, and contraindications for these treatments, alternative treatment options are required. Neurostimulation is a non-pharmacological and non-psychotherapeutic approach that has been under study for diverse neuropsychiatric conditions in the form of electrical or magnetic stimulation of the brain. Repetitive transcranial magnetic stimulation (rTMS) is a neurostimulation method designed to generate magnetic fields and deliver magnetic pulses to stimulate the brain cortex. The magnetic pulses produce electrical currents in the brain which are not intense enough to provoke seizures, differentiating this method from other forms of neurostimulation that produce seizures. Although the exact rTMS mechanisms of action are not completely understood, rTMS seems to cause its beneficial effects through changes in neuroplasticity. Devices and protocols for rTMS are still evolving, becoming more efficient over time. There are still some challenges to be addressed, including further refinement of parameters (coil/device type, location, intensity, frequency, number of sessions, and duration of treatment); treatment cost and burden for patients; and treatment resistance. However, the efficacy, tolerability, and safety of some rTMS protocols have been demonstrated in different double-blind sham-controlled randomized controlled trials and meta-analyses for treatment-resistant depression.
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Affiliation(s)
- Vitor Breda
- Department of Psychiatry, Western University, London, ON, Canada
- Victoria Hospital & Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Rafael Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
- Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, ON, Canada.
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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Al-Ruhaili I, Al-Huseini S, Al-Kaabi S, Mahadevan S, Al-Sibani N, Al Balushi N, Islam MM, Jose S, Mehr GK, Al-Adawi S. An Evaluation of the Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) for the Management of Treatment-Resistant Depression with Somatic Attributes: A Hospital-Based Study in Oman. Brain Sci 2023; 13:1289. [PMID: 37759890 PMCID: PMC10526207 DOI: 10.3390/brainsci13091289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Depressive illnesses in non-Western societies are often masked by somatic attributes that are sometimes impervious to pharmacological agents. This study explores the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for people experiencing treatment-resistant depression (TRD) accompanied by physical symptoms. Data were obtained from a prospective study conducted among patients with TRD and some somatic manifestations who underwent 20 sessions of rTMS intervention from January to June 2020. The Hamilton Rating Scale for Depression (HAMD) was used for clinical evaluation. Data were analysed using descriptive and inferential techniques (multiple logistic regression) in SPSS. Among the 49 participants (mean age: 42.5 ± 13.3), there was a significant reduction in posttreatment HAMD scores compared to baseline (t = 10.819, p < 0.0001, and 95% CI = 8.574-12.488), indicating a clinical response. Approximately 37% of the patients responded to treatment, with higher response rates among men and those who remained in urban areas, had a history of alcohol use, and were subjected to the standard 10 HZ protocol. After adjusting for all extraneous variables, the rTMS protocol emerged as the only significant predictor of response to the rTMS intervention. To our knowledge, this is the first study to examine the effectiveness of rTMS in the treatment of somatic depression.
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Affiliation(s)
- Intisar Al-Ruhaili
- Psychiatry Residency Program, Oman Medical Specialty Board, Muscat 130, Oman;
| | - Salim Al-Huseini
- Department of Psychiatry, Al Masarra Hospital, Ministry of Health, Muscat 113, Oman; (S.A.-H.); (S.A.-K.)
| | - Said Al-Kaabi
- Department of Psychiatry, Al Masarra Hospital, Ministry of Health, Muscat 113, Oman; (S.A.-H.); (S.A.-K.)
| | - Sangeetha Mahadevan
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (N.A.B.)
| | - Nasser Al-Sibani
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (N.A.B.)
| | - Naser Al Balushi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (N.A.B.)
| | - M. Mazharul Islam
- Department of Statistics, College of Science, Sultan Qaboos University, Muscat 123, Oman;
| | - Sachin Jose
- Studies and Research Section, Oman Medical Specialty Board, Muscat 130, Oman;
| | - Gilda Kiani Mehr
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14588-89694, Iran;
| | - Samir Al-Adawi
- Department of Behavioral Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (N.A.B.)
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Brini S, Brudasca NI, Hodkinson A, Kaluzinska K, Wach A, Storman D, Prokop-Dorner A, Jemioło P, Bala MM. Efficacy and safety of transcranial magnetic stimulation for treating major depressive disorder: An umbrella review and re-analysis of published meta-analyses of randomised controlled trials. Clin Psychol Rev 2023; 100:102236. [PMID: 36587461 DOI: 10.1016/j.cpr.2022.102236] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/15/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We re-analysed data from published meta-analyses testing the effects of Transcranial Magnetic Stimulation (TMS) on Major Depressive Disorder (MDD) in adults. We applied up-to-date meta-analytic techniques for handling heterogeneity including the random-effects Hartung-Knapp-Sidik-Jonkman method and estimated 95% prediction intervals. Heterogeneity practices in published meta-analyses were assessed as a secondary aim. STUDY DESIGN AND SETTING We performed systematic searches of systematic reviews with meta-analyses that included randomised controlled trials assessing the efficacy, tolerability, and side effects of TMS on MDD. We performed risk of bias assessment using A MeaSurement Tool to Assess Reviews (AMSTAR) 2 and re-analysed meta-analyses involving 10 or more primary studies. RESULTS We included 29 systematic reviews and re-analysed 15 meta-analyses. Authors of all meta-analyses interpreted findings to suggest TMS is safe and effective for MDD. Our re-analysis showed that in 14 out of 15 meta-analyses, the 95% prediction intervals included the null and captured values in the opposite effect direction. We also detected presence of small-study effects in some meta-analyses and 24 out of 25 systematic reviews received an AMSTAR 2 rating classed as critically low. CONCLUSION Authors of all included meta-analyses interpreted findings to suggest TMS is safe and effective for MDD despite lack of comprehensive investigation of heterogeneity. Our re-analysis revealed the direction and magnitude of treatment effects vary widely across different settings. We also found high risk of bias in the majority of included systematic reviews and presence of small-study effects in some meta-analyses. Because of these reasons, we argue TMS for MDD may not be as effective and potentially less tolerated in some populations than current evidence suggests.
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Affiliation(s)
- S Brini
- Division of Health Services Research and Management School of Health Sciences, City, University of London, London, United Kingdom.
| | - N I Brudasca
- Division of Health Services Research and Management School of Health Sciences, City, University of London, London, United Kingdom
| | - A Hodkinson
- National Institute for Health Research (NIHR), School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - K Kaluzinska
- Jagiellonian University Medical College, Faculty of Medicine, Students' Scientific Group of Systematic Reviews, Kraków, Poland
| | - A Wach
- Jagiellonian University Medical College, Faculty of Medicine, Students' Scientific Group of Systematic Reviews, Kraków, Poland
| | - D Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - A Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, Kraków, Poland
| | - P Jemioło
- AGH University of Science and Technology, Kraków, Poland
| | - M M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
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Efficacy and safety of simultaneous rTMS-tDCS over bilateral angular gyrus on neuropsychiatric symptoms in patients with moderate Alzheimer's disease: A prospective, randomized, sham-controlled pilot study. Brain Stimul 2022; 15:1530-1537. [PMID: 36460293 DOI: 10.1016/j.brs.2022.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/14/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Treating neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) remains highly challenging. Noninvasive brain stimulation using repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) is of considerable interest in this context. OBJECTIVE To investigate the efficacy and safety of a novel technique involving simultaneous application of rTMS and tDCS (rTMS-tDCS) over bilateral angular gyrus (AG, P5/P6 electrode site) for AD-related NPS. METHODS Eighty-four AD patients were randomized to receive rTMS-tDCS, single-rTMS, single-tDCS, or sham stimulation for 4 weeks, with evaluation at week-4 (W4, immediately after treatment) and week-12 (W12, follow-up period) after initial examination. Primary outcome comprising Neuropsychiatric Inventory (NPI) score and secondary outcomes comprising mini-mental state examination (MMSE), AD assessment scale-cognitive subscale (ADAS-cog), and Pittsburgh sleep quality index (PSQI) scores were collected and analyzed by a two-factor (time and treatment), mixed-design ANOVA. RESULTS rTMS-tDCS produced greater improvement in NPI scores than single-tDCS and sham at W4 and W12 (both P < 0.017) and trended better than single-rTMS (W4: P = 0.058, W12: P = 0.034). rTMS-tDCS improved MMSE scores compared with single-tDCS at W4 (P = 0.011) and sham at W4 and W12 (both P < 0.017). rTMS-tDCS also significantly improved PSQI compared with single-rTMS and sham (both P < 0.017). Interestingly, rTMS-tDCS-induced NPI/PSQI improvement was significantly associated with MMSE/ADAS-cog improvement. tDCS- and/or rTMS-related adverse events appeared slightly and briefly. CONCLUSIONS rTMS-tDCS application to bilateral AG can effectively improve AD-related NPS, cognitive function, and sleep quality with considerable safety.
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Diao Y, Geng M, Fu Y, Wang H, Liu C, Gu J, Dong J, Mu J, Liu X, Wang C. A combination of P300 and eye movement data improves the accuracy of auxiliary diagnoses of depression. J Affect Disord 2022; 297:386-395. [PMID: 34710500 DOI: 10.1016/j.jad.2021.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/09/2021] [Accepted: 10/20/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Exploratory eye movements (EEMs) and P300 are often used to facilitate the clinical diagnosis of depression. However, There were few studies using the combination of EEMs and P300 to build a model for detecting depression and predicting a curative effect. METHODS Sixty patients were recruited for 2 groups: high frequency repetitive transcranial magnetic stimulation(rTMS) combined with paroxetine group and simple paroxetine group. Clinical efficacy was evaluated by the Hamilton Depression scale-24(HAMD-24), EEMs and P300. The classification model of the auxiliary diagnosis of depression and the prediction model of the two treatments were developed based on a machine learning algorithm. RESULTS The classification model with the greatest accuracy for patients with depression and healthy controls was 95.24% (AUC = 0.75, recall = 1.00, precision = 0.95, F1-score = 0.97). The root mean square error (RMSE) of the model for predicting the efficacy of high frequency rTMS combined with paroxetine was 3.54 (MAE [mean absolute error] = 2.56, R2 = -0.53). The RMSE of the model for predicting the efficacy of paroxetine was 4.97 (MAE = 4.00, R2 = -0.91). CONCLUSION Based on the machine learning algorithm, P300 and EEMs data was suitable for modeling to distinguish depression patients and healthy individuals. However, it was not suitable for predicting the efficacy of high frequency rTMS combined with paroxetine or to predict the efficacy of paroxetine.
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Affiliation(s)
- Yunheng Diao
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China; The Second Clinical College, Xinxiang Medical University, Xinxiang, Henan, 453003, PR China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, Xinxiang, Henan, 453002, PR China
| | - Mengjun Geng
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China; The Second Clinical College, Xinxiang Medical University, Xinxiang, Henan, 453003, PR China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, Xinxiang, Henan, 453002, PR China
| | - Yifang Fu
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China; The Second Clinical College, Xinxiang Medical University, Xinxiang, Henan, 453003, PR China
| | - Huiying Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, Xinxiang, Henan, 453002, PR China
| | - Cong Liu
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China
| | - Jingyang Gu
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China
| | - Jiao Dong
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China
| | - Junlin Mu
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China
| | - Xianhua Liu
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China
| | - Changhong Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, 453002, PR China; The Second Clinical College, Xinxiang Medical University, Xinxiang, Henan, 453003, PR China; Henan Key Lab of Biological Psychiatry, Xinxiang Medical University, Xinxiang, Henan, 453002, PR China.
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11
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Li J, Cui L, Li H. Optimal parameter determination of repetitive transcranial magnetic stimulation for treating treatment-resistant depression: A network meta-analysis of randomized controlled trials. Front Psychiatry 2022; 13:1038312. [PMID: 36532172 PMCID: PMC9751374 DOI: 10.3389/fpsyt.2022.1038312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many studies have shown the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD). However, the choice of different parameters has been a challenging issue. METHODS PubMed, Cochrane, and Embase databases were searched for relevant studies until June 20, 2022. The treatment efficacy was evaluated by the relative risk (RR) using the pairwise test for response and remission rates. Subgroup and sensitivity analyses were conducted to explore the primary outcome differences and to assess the reliability of the results. RESULTS Thirty-seven trials comprising 2120 participants with TRD were included. The more efficacious interventions compared to sham controls included high-frequency left followed by low-frequency right sup-threshold (HFL-LFR-sup-rTMS, RR = 5.29, 95% CI: 1.24-22.50), high-frequency left sup-threshold (HFL-sup-rTMS, RR = 2.97, 95% CI: 1.74-5.05), low-frequency right sup-threshold (LFR-sup-rTMS, RR = 2.72, 95% CI: 1.50-4.90), low-frequency right followed by high-frequency left sup-threshold (LFR-HFL-sup-rTMS, RR = 2.71, 95% CI: 1.62-4.53), and high-frequency left sub-threshold (HFL-sub-rTMS, RR = 1.91, 95% CI: 1.18-3.10) rTMS. The estimated relative ranking of treatments suggested that HFL-LFR-sup-rTMS (84.4%) might be the most efficacious among all rTMS strategies. No treatments showed a lower acceptability than the sham control. LIMITATIONS Subgroup analysis was not conducted to compare the efficacy of rTMS treatment between bipolar and unipolar depression, and small-study effects possibly introduced bias. CONCLUSION Treatment with HFL-LFR-sup-rTMS, HFL-sup-rTMS, LFR-sup-rTMS, LFR-HFL-sup-rTMS, or HFL-sub-rTMS is more efficacious than the sham control. HFL-LFR-sup-rTMS and HFL-sup-rTMS may be the two best among the most efficacious rTMS treatments. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022334481].
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Affiliation(s)
- Jinbiao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Liqian Cui
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Hao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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12
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Razza LB, De Smet S, Moffa A, Sudbrack-Oliveira P, Vanderhasselt MA, Brunoni AR. Follow-up effects of transcranial direct current stimulation (tDCS) for the major depressive episode: A systematic review and meta-analysis. Psychiatry Res 2021; 302:114024. [PMID: 34058716 DOI: 10.1016/j.psychres.2021.114024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/15/2021] [Indexed: 12/17/2022]
Abstract
Transcranial Direct Current Stimulation (tDCS) is an effective treatment during the acute phase of a major depressive episode (MDE), although the evidence for its follow-up efficacy is mixed. A systematic review and meta-analysis were performed. MEDLINE/PubMed, Scopus (EMBASE), Web of Science, Cochrane Library and additional sources were searched from inception to April 29, 2021. Studies that followed up adults treated with tDCS during an MDE - using (interventional) and/or not using (observational) tDCS in the follow-up period were included. The primary outcome was the Hedges' g for the follow-up depression scores. Small study effects and sources of heterogeneity were explored. 427 studies were retrieved and 11 trials (13 datasets, n = 311) were included, most presenting moderate bias. Results showed a follow-up depression improvement (k = 13, g = -0.81, 95% confidence interval [CI]: -1.28; -0.34, I² = 84.0%), which was probably driven by the interventional studies (k = 7, g= -1.12, 95% CI: -1.84; -0.40, I² = 87.1%). No predictor of response was associated with the outcome. No risk of publication bias was found. Significant between-study heterogeneity may have influenced the overall results. Our findings suggest that tDCS produces effects beyond the intervention period during MDEs. Maintenance sessions are advised in future research.
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Affiliation(s)
- Laís B Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Clinical Hospital, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Stefanie De Smet
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium
| | - Adriano Moffa
- School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
| | - Pedro Sudbrack-Oliveira
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Clinical Hospital, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Psychiatry and Medical Psychology, Ghent University Hospital, Ghent University, Ghent, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Ghent, Belgium; Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - André R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Clinical Hospital, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Departamento de Medicina Interna, Faculdade de Medicina Universidade de São Paulo e Hospital Universitário, Universidade de São Paulo, Av. Prof Lineu Prestes 2565, 05508-000, São Paulo, Brazil
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13
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Turi Z, Normann C, Domschke K, Vlachos A. Transcranial Magnetic Stimulation in Psychiatry: Is There a Need for Electric Field Standardization? Front Hum Neurosci 2021; 15:639640. [PMID: 33767616 PMCID: PMC7985083 DOI: 10.3389/fnhum.2021.639640] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/16/2021] [Indexed: 01/29/2023] Open
Abstract
Single-pulse and repetitive transcranial magnetic stimulation (rTMS) are used in clinical practice for diagnostic and therapeutic purposes. However, rTMS-based therapies that lead to a significant and sustained reduction in neuropsychiatric symptoms remain scarce. While it is generally accepted that the stimulation frequency plays a crucial role in producing the therapeutic effects of rTMS, less attention has been dedicated to determining the role of the electric field strength. Conventional threshold-based intensity selection approaches, such as the resting motor threshold, produce variable stimulation intensities and electric fields across participants and cortical regions. Insufficient standardization of electric field strength may contribute to the variability of rTMS effects and thus therapeutic success. Computational approaches that can prospectively optimize the electric field and standardize it across patients and cortical targets may overcome some of these limitations. Here, we discuss these approaches and propose that electric field standardization will be instrumental for translational science frameworks (e.g., multiscale modeling and basic science approaches) aimed at deciphering the subcellular, cellular, and network mechanisms of rTMS. Advances in understanding these mechanisms will be important for optimizing rTMS-based therapies in psychiatry.
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Affiliation(s)
- Zsolt Turi
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claus Normann
- Department of Psychiatry and Psychotherapy, Medical Center—Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center—Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Vlachos
- Department of Neuroanatomy, Institute of Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center Brain Links Brain Tools, University of Freiburg, Freiburg, Germany
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14
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Predicting treatment effects in unipolar depression: A meta-review. Pharmacol Ther 2020; 212:107557. [PMID: 32437828 DOI: 10.1016/j.pharmthera.2020.107557] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/23/2020] [Indexed: 12/23/2022]
Abstract
There is increasing interest in clinical prediction models in psychiatry, which focus on developing multivariate algorithms to guide personalized diagnostic or management decisions. The main target of these models is the prediction of treatment response to different antidepressant therapies. This is because the ability to predict response based on patients' personal data may allow clinicians to make improved treatment decisions, and to provide more efficacious or more tolerable medications to the right patient. We searched the literature for systematic reviews about treatment prediction in the context of existing treatment modalities for adult unipolar depression, until July 2019. Treatment effect is defined broadly to include efficacy, safety, tolerability and acceptability outcomes. We first focused on the identification of individual predictor variables that might predict treatment response, and second, we considered multivariate clinical prediction models. Our meta-review included a total of 10 systematic reviews; seven (from 2014 to 2018) focusing on individual predictor variables and three focusing on clinical prediction models. These identified a number of sociodemographic, phenomenological, clinical, neuroimaging, remote monitoring, genetic and serum marker variables as possible predictor variables for treatment response, alongside statistical and machine-learning approaches to clinical prediction model development. Effect sizes for individual predictor variables were generally small and clinical prediction models had generally not been validated in external populations. There is a need for rigorous model validation in large external data-sets to prove the clinical utility of models. We also discuss potential future avenues in the field of personalized psychiatry, particularly the combination of multiple sources of data and the emerging field of artificial intelligence and digital mental health to identify new individual predictor variables.
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15
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Bulteau S, Laurin A, Volteau C, Dert C, Lagalice L, Schirr-Bonnans S, Bukowski N, Guitteny M, Simons L, Cabelguen C, Pichot A, Tessier F, Bonnin A, Lepage A, Vanelle JM, Sauvaget A, Riche VP. Cost-utility analysis of curative and maintenance repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant unipolar depression: a randomized controlled trial protocol. Trials 2020; 21:312. [PMID: 32248820 PMCID: PMC7133008 DOI: 10.1186/s13063-020-04255-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/14/2020] [Indexed: 12/28/2022] Open
Abstract
Background Depression is a debilitating and costly disease for our society, especially in the case of treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant therapy in treatment-resistant unipolar and non-psychotic depression. It can be applied according to two therapeutic strategies after an initial rTMS cure: a further rTMS cure can be performed at the first sign of relapse or recurrence, or systematic maintenance rTMS (M-rTMS) can be proposed. TMS adjuvant to treatment as usual (TAU) could improve long-term prognosis. However, no controlled study has yet compared the cost-effectiveness of these two additional rTMS therapeutic strategies versus TAU alone. Methods/design This paper focuses on the design of a health-economic, prospective, randomized, double-blind, multicenter study with three parallel arms carried out in France. This study assesses the cost-effectiveness of the adjunctive and maintenance low frequency rTMS on the right dorsolateral prefrontal cortex versus TAU alone. A total of 318 patients suffering from a current TRD will be enrolled. The primary endpoint is to investigate the incremental cost-effectiveness ratio (ICER) (ratio costs / quality-adjusted life-years [QALY] measured by the Euroqol Five Dimension Questionnaire) over 12 months in a population of patients assigned to one of three arms: systematic M-rTMS for responders (arm A); additional new rTMS cure in case of mood deterioration among responders (arm B); and a placebo arm (arm C) in which responders are allocated in two subgroups: sham systematic M-rTMS and supplementary rTMS course in case of mood deterioration. ICER and QALYs will be compared between arm A or B versus arm C. The secondary endpoints in each three arms will be: ICER at 24 months; the cost-utility ratio analysis at 12 and 24 months; 5-year budget impact analysis; and prognosis factors of rTMS. The following criteria will be compared between arm A or B and arm C: rates of responders; remission and disease-free survival; clinical evolution; tolerance; observance; treatment modifications; hospitalization; suicide attempts; work stoppage; marital / professional statues; and quality of life at 12 and 24 months. Discussion The purpose of our study is to check the cost-effectiveness of rTMS and we will discuss its economic impact over time. In the case of significant decrease in the depression costs and expenditures associated with a good long-term prognosis (sustained response and remission) and tolerance, rTMS could be considered as an efficient treatment within the armamentarium for resistant unipolar depression. Trial registration ClinicalTrials.gov, NCT03701724. Registered on 10 October 2018. Protocol Amendment Version 2.0 accepted on 29 June 2019.
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Affiliation(s)
- Samuel Bulteau
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France.
| | - Andrew Laurin
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Cécile Dert
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Lydie Lagalice
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Nicolas Bukowski
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Marie Guitteny
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Luc Simons
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Anne Pichot
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Fabienne Tessier
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Annabelle Bonnin
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Adeline Lepage
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | | | | | - Anne Sauvaget
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
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16
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Borrione L, Bellini H, Razza LB, Avila AG, Baeken C, Brem AK, Busatto G, Carvalho AF, Chekroud A, Daskalakis ZJ, Deng ZD, Downar J, Gattaz W, Loo C, Lotufo PA, Martin MDGM, McClintock SM, O'Shea J, Padberg F, Passos IC, Salum GA, Vanderhasselt MA, Fraguas R, Benseñor I, Valiengo L, Brunoni AR. Precision non-implantable neuromodulation therapies: a perspective for the depressed brain. ACTA ACUST UNITED AC 2020; 42:403-419. [PMID: 32187319 PMCID: PMC7430385 DOI: 10.1590/1516-4446-2019-0741] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
Current first-line treatments for major depressive disorder (MDD) include pharmacotherapy and cognitive-behavioral therapy. However, one-third of depressed patients do not achieve remission after multiple medication trials, and psychotherapy can be costly and time-consuming. Although non-implantable neuromodulation (NIN) techniques such as transcranial magnetic stimulation, transcranial direct current stimulation, electroconvulsive therapy, and magnetic seizure therapy are gaining momentum for treating MDD, the efficacy of non-convulsive techniques is still modest, whereas use of convulsive modalities is limited by their cognitive side effects. In this context, we propose that NIN techniques could benefit from a precision-oriented approach. In this review, we discuss the challenges and opportunities in implementing such a framework, focusing on enhancing NIN effects via a combination of individualized cognitive interventions, using closed-loop approaches, identifying multimodal biomarkers, using computer electric field modeling to guide targeting and quantify dosage, and using machine learning algorithms to integrate data collected at multiple biological levels and identify clinical responders. Though promising, this framework is currently limited, as previous studies have employed small samples and did not sufficiently explore pathophysiological mechanisms associated with NIN response and side effects. Moreover, cost-effectiveness analyses have not been performed. Nevertheless, further advancements in clinical trials of NIN could shift the field toward a more “precision-oriented” practice.
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Affiliation(s)
- Lucas Borrione
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Helena Bellini
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lais Boralli Razza
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Ana G Avila
- Centro de Neuropsicologia e Intervenção Cognitivo-Comportamental, Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Chris Baeken
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Munich, Germany.,Division of Interventional Cognitive Neurology, Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Geraldo Busatto
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Adam Chekroud
- Spring Health, New York, NY, USA.,Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutic & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, NC, USA
| | - Jonathan Downar
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Mental Health and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Wagner Gattaz
- Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Colleen Loo
- School of Psychiatry and Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Paulo A Lotufo
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Maria da Graça M Martin
- Laboratório de Ressonância Magnética em Neurorradiologia (LIM-44) and Instituto de Radiologia, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Shawn M McClintock
- Neurocognitive Research Laboratory, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacinta O'Shea
- Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Human Brain Activity, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ives C Passos
- Laboratório de Psiquiatria Molecular e Programa de
Transtorno Bipolar, Hospital de Clínicas de Porto Alegre (HCPA), Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Giovanni A Salum
- Departamento de Psiquiatria, Seção de Afeto Negativo e Processos Sociais (SANPS), HCPA, UFRGS, Porto Alegre, RS, Brazil
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Psychopathology and Affective Neuroscience Lab, Ghent University, Ghent, Belgium
| | - Renerio Fraguas
- Laboratório de Neuroimagem em Psiquiatria (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Isabela Benseñor
- Estudo Longitudinal de Saúde do Adulto (ELSA), Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, USP, São Paulo, SP, Brazil
| | - Leandro Valiengo
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Andre R Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Laboratório de Neurociências (LIM-27), Departamento e Instituto de Psiquiatria, Hospital das Clínicas,
Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBioN), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil.,Hospital Universitário, USP, São Paulo, SP, Brazil
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Miljevic A, Bailey NW, Herring SE, Fitzgerald PB. Potential predictors of depressive relapse following repetitive Transcranial Magnetic Stimulation: A systematic review. J Affect Disord 2019; 256:317-323. [PMID: 31201982 DOI: 10.1016/j.jad.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/12/2019] [Accepted: 06/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) is widely approved treatment for major depressive disorder (MDD). However, around 50% of individuals who recover from depression following rTMS interventions experience a relapse of depressive symptomatology by 12 months. The short-term durability of the rTMS treatment effect has been systematically investigated. However, variables relating to the long-term durability of the antidepressant effect produced by rTMS are less understood. Therefore, the current review systematically assessed the research on variables relating to relapse following rTMS. METHOD This systematic review was performed according to PRISMA guidelines. A comprehensive electronic literature search for terms related to relapse following rTMS treatment for MDD was performed on studies published before the end of October 2018. RESULTS A total of 18 studies assessing relapse related variables were identified. While there is some indication that comorbid anxiety, acute response, and residual symptomatology may hold predictive potential for depressive relapse following rTMS treatment, findings were not sufficient to draw reliable conclusions. DISCUSSION Identified studies assessed three main categories of variables including demographic information, clinical characteristics and rating scale scores, and rTMS treatment specific factors. Only a small number of studies were available, and considerable inconsistency exists between studies, only limited conclusions were able to be drawn. CONCLUSION More studies assessing a wider range of predictor variables such as cognitive or neuroimaging markers are needed.
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Affiliation(s)
- Aleksandra Miljevic
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Alfred Hospital, 607 St Kilda Rd, Melbourne, Victoria 3004, Australia; Epworth Centre for Innovation in Mental Health, Epworth HealthCare, 888 Toorak Rd, Camberwell, Victoria 3124, Australia.
| | - Neil W Bailey
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Alfred Hospital, 607 St Kilda Rd, Melbourne, Victoria 3004, Australia; Epworth Centre for Innovation in Mental Health, Epworth HealthCare, 888 Toorak Rd, Camberwell, Victoria 3124, Australia.
| | - Sally E Herring
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, 888 Toorak Rd, Camberwell, Victoria 3124, Australia.
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University, Alfred Hospital, 607 St Kilda Rd, Melbourne, Victoria 3004, Australia; Epworth Centre for Innovation in Mental Health, Epworth HealthCare, 888 Toorak Rd, Camberwell, Victoria 3124, Australia.
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18
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Somani A, Kar SK. Efficacy of repetitive transcranial magnetic stimulation in treatment-resistant depression: the evidence thus far. Gen Psychiatr 2019; 32:e100074. [PMID: 31552384 PMCID: PMC6738665 DOI: 10.1136/gpsych-2019-100074] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022] Open
Abstract
Depression is a common mental disorder, which attributes to significant morbidity, disability and burden of care. A significant number of patients with depression still remain symptomatic after adequate trials of antidepressant treatment as well as psychotherapy, which is often referred to as treatment-resistant depression. Neuromodulation techniques-like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation, may be useful augmenting techniques in depression, mostly recommended for treatment-resistant cases. Robust evidence exists regarding the efficacy of electroconvulsive therapy in the management of treatment-resistant depression; however, other techniques are understudied. TMS has been increasingly studied in various psychiatric disorders including depression. It has been approved by the US Food and Drug Administration for use in major depressive disorder. Over the past two decades, TMS has been studied in diverse groups of the population with depression using several research designs. This article gives an overview of the efficacy of repetitive TMS in treatment-resistant depression with the recent evidence.
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Affiliation(s)
- Aditya Somani
- Department of Psychiatry, Mental Health Institute, Chandigarh, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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Chen L, Chung SW, Hoy KE, Fitzgerald PB. Is theta burst stimulation ready as a clinical treatment for depression? Expert Rev Neurother 2019; 19:1089-1102. [PMID: 31282224 DOI: 10.1080/14737175.2019.1641084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Major depression is a common and debilitating mental disorder that can be difficult to treat. Substantive evidence over the past two decades has established repetitive transcranial magnetic stimulation (rTMS) as an effective antidepressant therapy, although scope exists to improve its efficacy and efficiency. Theta burst stimulation (TBS) is a novel rTMS pattern attracting much research interest as a tool to study neurophysiology and treat neuropsychiatric disorders. Areas covered: This article outlines rTMS' state of development and explores the physiology studies underpinning TBS development and its observable neuronal conditioning and metabolic effects. We present a systematic review of studies that applied TBS to treat depression, followed by commentary on safety and practical considerations. Expert opinion: Much experimental and clinical research have advanced our understanding of the antidepressant effects of TBS, although unanswered questions remain relating to its physiological effects, response variability and optimal parameters for therapeutic purposes. A small number of sham-controlled trials, and one large comparative trial, support the therapeutic efficacy of TBS and demonstrates its non-inferiority relative to traditional rTMS. In this light, TBS can reasonably be offered as an alternative to rTMS in treatment-resistant depression, while ongoing research is likely to inform its therapeutic potential.
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Affiliation(s)
- Leo Chen
- Monash Alfred Psychiatry Research Centre, Monash University , Melbourne , VIC , Australia.,Epworth Centre for Innovation in Mental Health, Epworth Health Care , Camberwell , VIC , Australia.,Alfred Mental and Addiction Health, Alfred Health , Melbourne , Australia
| | - Sung Wook Chung
- Monash Alfred Psychiatry Research Centre, Monash University , Melbourne , VIC , Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, Monash University , Melbourne , VIC , Australia.,Epworth Centre for Innovation in Mental Health, Epworth Health Care , Camberwell , VIC , Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University , Melbourne , VIC , Australia.,Epworth Centre for Innovation in Mental Health, Epworth Health Care , Camberwell , VIC , Australia
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20
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Bulteau S, Guirette C, Brunelin J, Poulet E, Trojak B, Richieri R, Szekely D, Bennabi D, Yrondi A, Rotharmel M, Bougerol T, Dall’Igna G, Attal J, Benadhira R, Bouaziz N, Bubrovszky M, Calvet B, Dollfus S, Foucher J, Galvao F, Gay A, Haesebaert F, Haffen E, Jalenques I, Januel D, Jardri R, Millet B, Nathou C, Nauczyciel C, Plaze M, Rachid F, Vanelle JM, Sauvaget A. Troubles de l’humeur : quand recourir à la stimulation magnétique transcrânienne ? Presse Med 2019; 48:625-646. [DOI: 10.1016/j.lpm.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/30/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
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21
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Gellersen HM, Kedzior KK. Antidepressant outcomes of high-frequency repetitive transcranial magnetic stimulation (rTMS) with F8-coil and deep transcranial magnetic stimulation (DTMS) with H1-coil in major depression: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:139. [PMID: 31064328 PMCID: PMC6505129 DOI: 10.1186/s12888-019-2106-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The current study aims to systematically assess and compare the antidepressant outcomes of repetitive transcranial magnetic stimulation (rTMS) with the figure-of-eight (F8)-coil and deep transcranial magnetic stimulation (DTMS) with the H1-coil in studies matched on stimulation frequency in unipolar major depressive disorder (MDD). METHODS Electronic search of Medline and PsycInfo identified 19 studies with stimulation frequency of 18-20 Hz using F8-coil (k = 8 randomised sham-controlled trials, RCTs, k = 3 open-label; n = 168 patients) or H1-coil (k = 1 RCT, k = 7 open-label; n = 200). Depression severity (the primary outcome) and response/remission rates (the secondary outcomes) were assessed at session 10. RESULTS Effects pooled with random-effects meta-analysis showed a large reduction in depression severity, 29% response, and 15% remission rates after 10 sessions of active stimulation with either coil relative to baseline. Reduction in depression severity was greater in studies with younger patients using either coil. The comparison between coils showed a larger reduction in depression severity in H1-coil vs. F8-coil studies (independent of the study design or the concurrent pharmacotherapy) and a trend towards higher remission rates in F8-coil vs. H1-coils studies. These effects are based on a low volume of studies, are not controlled for placebo, and may not be clinically-relevant. The stimulation protocols differed systematically because stimulation was more focal but less intense (80-110% of the resting motor threshold, MT) in the F8-coil studies and less focal but more intense (120% MT) in the H1-coil studies. Two seizures occurred in the H1-coil studies relative to none in the F8-coil studies. CONCLUSION When matched on frequency, the higher-intensity and less focal stimulation with the H1-coil reduces depression more than the lower-intensity and more focal stimulation with the F8-coil. Head-to-head trials should compare the antidepressant outcomes of F8-coil and H1-coil to identify the most optimal stimulation protocols for acute and longer-lasting efficacy.
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Affiliation(s)
- Helena M. Gellersen
- 0000000121885934grid.5335.0Department of Psychology, University of Cambridge, Cambridge, UK
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22
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Aparicio LVM, Rosa V, Razza LM, Sampaio-Junior B, Borrione L, Valiengo L, Lotufo PA, Benseñor IM, Fraguas R, Moffa AH, Gattaz WF, Brunoni AR. Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: Results of a 6-month follow-up. Depress Anxiety 2019; 36:262-268. [PMID: 30637889 DOI: 10.1002/da.22878] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/18/2018] [Accepted: 11/30/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The efficacy of transcranial direct current stimulation (tDCS) as a continuation therapy for the maintenance phase of the depressive episode is low and insufficiently investigated in literature. We investigated whether it could be enhanced by using a more intensive treatment regimen compared to previous reports. METHODS Twenty-four patients (16 with unipolar depression and eight with bipolar depression) who presented acute tDCS response (≥50% depression improvement in the Hamilton Depression Rating Scale [HDRS]) after receiving 15 tDCS sessions were followed for up to 6 months or until relapse, defined as clinical worsening and/or HDRS > 15. Sessions were performed twice a week (maximum of 48 sessions) over 24 weeks. The anode and the cathode were positioned over the left and right dorsolateral prefrontal cortex (2 mA current, 30 min sessions were delivered). We performed Kaplan-Meier survival analysis and Cox proportional hazards ratios to evaluate predictors of relapse. RESULTS Out of 24 patients, 18 completed the follow-up period. tDCS treatment was well tolerated. The mean survival duration was 17.5 weeks (122 days). The survival rate at the end of follow-up was 73.5% (95% confidence interval, 50-87). A trend (P = 0.09) was observed for lower relapse rates in nontreatment- vs. antidepressant treatment-resistant patients (7.7% vs. 45.5%, respectively). No differences in efficacy between unipolar and bipolar depression were observed. CONCLUSION An intensive tDCS treatment regimen consisting of sessions twice a week achieved relatively low relapse rates after a 6-month follow up of tDCS responders, particularly for nontreatment-resistant patients.
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Affiliation(s)
- Luana V M Aparicio
- University Hospital, University of São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Vivianne Rosa
- University Hospital, University of São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lais M Razza
- University Hospital, University of São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Bernardo Sampaio-Junior
- University Hospital, University of São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Borrione
- University Hospital, University of São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro Valiengo
- Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Paulo A Lotufo
- University Hospital, University of São Paulo, São Paulo, Brazil
| | | | - Renerio Fraguas
- University Hospital, University of São Paulo, São Paulo, Brazil.,Laboratory of Psychiatric Neuroimaging (LIM-21), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Adriano H Moffa
- University Hospital, University of São Paulo, São Paulo, Brazil.,School of Psychiatry, Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Wagner F Gattaz
- Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - André Russowsky Brunoni
- University Hospital, University of São Paulo, São Paulo, Brazil.,Service of Interdisciplinary Neuromodulation (SIN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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23
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Kar SK. Predictors of Response to Repetitive Transcranial Magnetic Stimulation in Depression: A Review of Recent Updates. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:25-33. [PMID: 30690937 PMCID: PMC6361049 DOI: 10.9758/cpn.2019.17.1.25] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/22/2018] [Accepted: 06/14/2018] [Indexed: 12/29/2022]
Abstract
Transcranial magnetic stimulation (TMS) has been increasingly used in the treatment of various neuropsychiatric disorders including depression over the past two decades. The responses to treatment with TMS are variable as found in the recent studies. Evidences suggest that various factors influence the outcome of depression treated with TMS. Understanding the predictors of response to TMS treatment in depression will guide the clinician in appropriate selection of patients for TMS treatment as well as needful modification in the TMS technique and protocol to have a better clinical outcome. This article comprehensively reviews the factors that predict the outcome of TMS treatment in depression.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, India
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24
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Combining attentional bias modification with dorsolateral prefrontal rTMS does not attenuate maladaptive attentional processing. Sci Rep 2019; 9:1168. [PMID: 30718539 PMCID: PMC6362221 DOI: 10.1038/s41598-018-37308-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/22/2018] [Indexed: 11/08/2022] Open
Abstract
High frequency repetitive Transcranial Magnetic Stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been shown to reduce depressive symptoms and improve cognitive biases such as attentional bias. One promising technique that may complement rTMS treatment is attentional bias modification (ABM) training, given the similarity in modulating attentional bias and affecting neuronal activity. We tested whether the combination of rTMS treatment and ABM training in a single session would attenuate maladaptive attentional processing and improve mood in participants with subclinical depressive symptoms. To this end, 122 healthy participants were randomly assigned to one of four groups, receiving either a single rTMS treatment, a single ABM treatment, a combination of rTMS and ABM or a sham treatment. Of these 122 participants, 72 showed a heightened BDI-II score (between 9 and 25) and were included in our main analyses. In our subclinical (≥9 and ≤25 BDI-II) sample, a single combination treatment of rTMS and ABM training induced no significant changes in attentional bias, attentional control or mood, nor did rTMS alone affect attentional bias systematically. We discuss these null findings in light of the task specifics and relate them to the ongoing discussion on ABM training in depression.
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25
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Senova S, Cotovio G, Pascual-Leone A, Oliveira-Maia AJ. Durability of antidepressant response to repetitive transcranial magnetic stimulation: Systematic review and meta-analysis. Brain Stimul 2019; 12:119-128. [PMID: 30344109 DOI: 10.1016/j.brs.2018.10.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/21/2018] [Accepted: 10/01/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The therapeutic options for treatment-resistant depression (TRD) encompass a range of neuromodulatory techniques, including repetitive transcranial magnetic stimulation (rTMS). While rTMS is safe and has documented short-term efficacy, durability of antidepressant effects is poorly established. OBJECTIVE Assess existing evidence regarding durability of rTMS-induced antidepressant response. METHODS We performed a systematic review of studies reporting antidepressant outcome measures collected three or more months after the end of an induction course of rTMS for depression. Among responders to the induction course, we used a meta-analytic approach to assess response rates at 3 (m3), 6 (m6) or 12 (m12) months after induction, and studied predictors of responder rates using meta-regression. RESULTS Nineteen studies published between 2002 and 2018 were included. Eighteen were eligible for analysis at m3 (732 patients) and m6 (695 patients) and 9 at m12 (247 patients). Among initial responders, 66.5% sustained response at m3 (95% CI = 57.1-74.8%, I2 = 27.6%), 52.9% at m6 (95% CI = 40.3-65%, I2 = 0%), and 46.3% at m12 (95% CI = 32.6-60.7%, I2 = 0%), in the absence of any major bias. Random-effects meta-regressions further demonstrated that a higher proportion of women, as well as receipt of maintenance treatment, predicted higher responder rates at specific time-points. CONCLUSIONS rTMS is a durable treatment for depression, with sustained responder rates of 50% up to 1 year after a successful induction course of treatment. Maintenance treatment may enhance the durability of the antidepressant effects of rTMS, and should be considered in clinical practice, as well as systematically explored in future clinical trials.
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Affiliation(s)
- Suhan Senova
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal; Neurosurgery and PePsy Departments, Assistance Publique-Hôpitaux de Paris (APHP), Groupe Henri-Mondor Albert-Chenevier, Créteil, France; Equipe 14, U955 INSERM, Institut Mondor de Recherche Biomedicale and Faculté de Médecine, Université Paris Est, Créteil, France
| | - Gonçalo Cotovio
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal; Champalimaud Research, Champalimaud Centre for the Unknown, Lisboa, Portugal
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Institut Guttmann de Neurorehabilitación, Universitat Autonoma de Barcelona, Badalona, Barcelona, Spain
| | - Albino J Oliveira-Maia
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisboa, Portugal; Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal; Champalimaud Research, Champalimaud Centre for the Unknown, Lisboa, Portugal.
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26
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Valkonen-Korhonen M, Leinola H, Könönen M, Niskanen E, Purhonen M, Pakarinen M, Ruusunen A, Lehto SM, Mervaala E, Honkalampi K, Koivumaa-Honkanen H, Viinamäki H. Bifrontal active and sham rTMS in treatment-resistant unipolar major depression. Nord J Psychiatry 2018; 72:586-592. [PMID: 30348049 DOI: 10.1080/08039488.2018.1500640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM Prevention of the recurrence of major depression and its residual symptoms requires effective treatment. Our aim was to study the effects of bifrontal active rTMS controlled by sham rTMS in treatment-resistant unipolar major depressive disorder (MDD). METHODS Thirty-seven patients with treatment-resistant MDD were randomized into two groups. One group received a total of 30 sessions of active bifrontal rTMS (10 Hz rTMS on left dorsolateral prefrontal cortex (DLPFC) and 1 Hz rTMS on right DLPFC) and the other group received bilateral sham rTMS on five days a week for six weeks. RESULTS Depressive symptoms significantly improved in both the groups, but without a significant group difference. Furthermore, patients with psychotic depression improved similarly to those with moderate or severe depression. CONCLUSIONS The results of present study indicate a large sham effect of stimulation treatment. The intensive structured treatment protocol may explain the positive outcome in both the groups. It is important to recognize, appreciate, and utilize placebo effects as a significant means of rehabilitation in psychiatric care.
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Affiliation(s)
- Minna Valkonen-Korhonen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland
| | - Hanna Leinola
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland
| | - Mervi Könönen
- b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,c Department of Clinical Neurophysiology , Kuopio University Hospital , Kuopio , Finland
| | - Eini Niskanen
- d Department of Applied Physics , University of Eastern Finland , Kuopio , Finland
| | - Maija Purhonen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland
| | - Maarit Pakarinen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland
| | - Anu Ruusunen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,e Food and Mood Centre/IMPACT SRC School of Medicine , Deakin University , Geelong , Australia
| | - Soili M Lehto
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,f Department of Psychology and Logopedics Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - Esa Mervaala
- b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,c Department of Clinical Neurophysiology , Kuopio University Hospital , Kuopio , Finland.,g Institute of Clinical Medicine/Clinical Neurophysiology , University of Eastern Finland , Kuopio , Finland
| | - Kirsi Honkalampi
- h School of Educational Sciences and Psychology , University of Eastern Finland , Joensuu , Finland
| | - Heli Koivumaa-Honkanen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,i Departments of Psychiatry: North Karelia Central Hospital , Joensuu , Finland.,j SOTE , Iisalmi , Finland.,k South-Savonia Hospital District , Mikkeli , Finland.,l Lapland Hospital District , Rovaniemi , Finland
| | - Heimo Viinamäki
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland
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27
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Svensson AF, Khaldi M, Engström I, Matusevich K, Nordenskjöld A. Remission rate of transcranial magnetic stimulation compared with electroconvulsive therapy: a case-control study. Nord J Psychiatry 2018; 72:471-476. [PMID: 30359165 DOI: 10.1080/08039488.2018.1481998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the rate of remission, rate of response, change in depressive symptoms, and adverse effects between repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT). MATERIALS AND METHODS In this retrospective case-control study, 35 patients treated for depression with rTMS (left dorsolateral prefrontal cortex, 90% observed motor threshold, 10 Hz, 2000 pulses/session, 15 sessions) at Örebro University Hospital, Sweden (cases), were compared with a matched group of 35 patients treated for depression with ECT (controls). Data on controls were obtained from the Swedish National Quality Register for ECT (Q-ECT). Severity of depression was evaluated using the Montgomery-Åsberg Depression rating scale (MADRS). RESULTS Remission rate was 26% for cases and 43% for controls (p = .3). Response rate was 40% for cases and 51% for controls (p = .63). The median decrease in MADRS was 11 (IQR 3-19) vs. 17 (IQR 6-27; p = .10) for rTMS and ECT, respectively. There was no statistically significant difference in any measure of treatment effect between rTMS and ECT. More than half of the patients of the rTMS group experienced scalp discomfort and 11% of the ECT group had memory disturbances. CONCLUSIONS All measures of therapeutic efficacy were numerically inferior in the rTMS group compared to the ECT group. The differences were not statistically significant, probably because the sample size was small. More studies are required to find the optimal place for rTMS within the Swedish health care system. Such studies could be facilitated by inclusion of rTMS in the Q-ECT.
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Affiliation(s)
| | - Maher Khaldi
- a School of Medical Sciences , Örebro University , Örebro , Sweden
| | - Ingemar Engström
- b School of Medical Sciences , University Health Care Research Center, Örebro University , Sweden
| | | | - Axel Nordenskjöld
- b School of Medical Sciences , University Health Care Research Center, Örebro University , Sweden
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28
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Garnaat SL, Yuan S, Wang H, Philip NS, Carpenter LL. Updates on Transcranial Magnetic Stimulation Therapy for Major Depressive Disorder. Psychiatr Clin North Am 2018; 41:419-431. [PMID: 30098655 PMCID: PMC6979370 DOI: 10.1016/j.psc.2018.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Transcranial magnetic stimulation has emerged as a treatment option for treatment-resistant depression. While existing data largely support efficacy of transcranial magnetic stimulation for major depressive disorder, ongoing research aims to optimize treatment parameters and identify biomarkers of treatment response. In this article, the authors describe data from controlled trials and ongoing efforts to enhance transcranial magnetic stimulation outcomes for major depressive disorder. Findings from preliminary research aimed at identifying neuroimaging and neurophysiological biomarkers of transcranial magnetic stimulation effects are discussed.
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Affiliation(s)
- Sarah L. Garnaat
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Butler Hospital, Providence, RI, USA
| | - Shiwen Yuan
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Haizhi Wang
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Noah S. Philip
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Butler Hospital, Providence, RI, USA,Providence VA Medical Center, Providence, RI, USA
| | - Linda L. Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Butler Hospital, Providence, RI, USA
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Verma R, Kumar N, Kumar S. Effectiveness of adjunctive repetitive transcranial magnetic stimulation in management of treatment-resistant depression: A retrospective analysis. Indian J Psychiatry 2018; 60:329-333. [PMID: 30405260 PMCID: PMC6201665 DOI: 10.4103/psychiatry.indianjpsychiatry_182_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is limited number of studies from India investigating role of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD). This clinic-based study reports on the efficacy of rTMS as an add-on treatment in patients suffering from TRD. MATERIALS AND METHODS Twenty-two right-handed patients suffering from major depressive disorder who failed to respond to adequate trials of at least two antidepressants drugs in the current episode received rTMS as an augmenting treatment. High-frequency (Hf) rTMS at 110% of the estimated resting motor threshold (MT) was given over the left dorsolateral prefrontal cortex (DLPFC). A total of 15 sessions were given over 3 weeks with 3000 pulses per session. The outcome was assessed based on the changes in scores of Hamilton Rating Scale for Depression or Montgomery-Asberg Depression Rating Scale. RESULTS There was a significant reduction in final assessment scores after rTMS intervention as compared to baseline with almost 50% of the participants showing response in either scale. CONCLUSION Hf rTMS applied over left DLPFC is an effective add-on treatment strategy in patients with TRD.
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Affiliation(s)
- Rohit Verma
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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30
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Cocchi L, Zalesky A, Nott Z, Whybird G, Fitzgerald PB, Breakspear M. Transcranial magnetic stimulation in obsessive-compulsive disorder: A focus on network mechanisms and state dependence. NEUROIMAGE-CLINICAL 2018; 19:661-674. [PMID: 30023172 PMCID: PMC6047114 DOI: 10.1016/j.nicl.2018.05.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023]
Abstract
Background Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique that has shown promise as an adjunct treatment for the symptoms of Obsessive-Compulsive Disorder (OCD). Establishing a clear clinical role for TMS in the treatment of OCD is contingent upon evidence of significant efficacy and reliability in reducing symptoms. Objectives We present the basic principles supporting the effects of TMS on brain activity with a focus on network-based theories of brain function. We discuss the promises and pitfalls of this technique as a means of modulating brain activity and reducing OCD symptoms. Methods Synthesis of trends and critical perspective on the potential benefits and limitations of TMS interventions in OCD. Findings Our critical synthesis suggests the need to better quantify the role of TMS in a clinical setting. The context in which the stimulation is performed, the neural principles supporting the effects of local stimulation on brain networks, and the heterogeneity of neuroanatomy are often overlooked in the clinical application of TMS. The lack of consideration of these factors may partly explain the variable efficacy of TMS interventions for OCD symptoms. Conclusions Results from existing clinical studies and emerging knowledge about the effects of TMS on brain networks are encouraging but also highlight the need for further research into the use of TMS as a means of selectively normalising OCD brain network dynamics and reducing related symptoms. The combination of neuroimaging, computational modelling, and behavioural protocols known to engage brain networks affected by OCD has the potential to improve the precision and therapeutic efficacy of TMS interventions. The efficacy of this multimodal approach remains, however, to be established and its effective translation in clinical contexts presents technical and implementation challenges. Addressing these practical, scientific and technical issues is required to assess whether OCD can take its place alongside major depressive disorder as an indication for the use of TMS.
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Affiliation(s)
- Luca Cocchi
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia; Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Zoie Nott
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Paul B Fitzgerald
- Epworh Clinic Epworth Healthcare, Camberwell, Victoria Australia and the MAPrc, Monash University Central Clinical School and The Alfred, Melbourne, Australia
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31
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Targeted neural network interventions for auditory hallucinations: Can TMS inform DBS? Schizophr Res 2018; 195:455-462. [PMID: 28969932 PMCID: PMC8141945 DOI: 10.1016/j.schres.2017.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/30/2017] [Accepted: 09/14/2017] [Indexed: 12/30/2022]
Abstract
The debilitating and refractory nature of auditory hallucinations (AH) in schizophrenia and other psychiatric disorders has stimulated investigations into neuromodulatory interventions that target the aberrant neural networks associated with them. Internal or invasive forms of brain stimulation such as deep brain stimulation (DBS) are currently being explored for treatment-refractory schizophrenia. The process of developing and implementing DBS is limited by symptom clustering within psychiatric constructs as well as a scarcity of causal tools with which to predict response, refine targeting or guide clinical decisions. Transcranial magnetic stimulation (TMS), an external or non-invasive form of brain stimulation, has shown some promise as a therapeutic intervention for AH but remains relatively underutilized as an investigational probe of clinically relevant neural networks. In this editorial, we propose that TMS has the potential to inform DBS by adding individualized causal evidence to an evaluation processes otherwise devoid of it in patients. Although there are significant limitations and safety concerns regarding DBS, the combination of TMS with computational modeling of neuroimaging and neurophysiological data could provide critical insights into more robust and adaptable network modulation.
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32
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Müller HHO, Moeller S, Lücke C, Lam AP, Braun N, Philipsen A. Vagus Nerve Stimulation (VNS) and Other Augmentation Strategies for Therapy-Resistant Depression (TRD): Review of the Evidence and Clinical Advice for Use. Front Neurosci 2018; 12:239. [PMID: 29692707 PMCID: PMC5902793 DOI: 10.3389/fnins.2018.00239] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/27/2018] [Indexed: 12/21/2022] Open
Abstract
In addition to electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS), vagus nerve stimulation (VNS) is one of the approved neurostimulation tools for treatment of major depression. VNS is particularly used in therapy-resistant depression (TRD) and exhibits antidepressive and augmentative effects. In long-term treatment, up to two-thirds of patients respond. This mini-review provides a comprehensive overview of augmentation pharmacotherapy and neurostimulation-based treatment strategies, with a special focus on VNS in TRD, and provides practical clinical advice for how to select TRD patients for add-on neurostimulation treatment strategies.
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Affiliation(s)
- Helge H O Müller
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian Moeller
- Department of Psychiatry and Psychotherapy, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Caroline Lücke
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany
| | - Alexandra P Lam
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Bonn, Bonn, Germany
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33
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McClintock SM, Reti IM, Carpenter LL, McDonald WM, Dubin M, Taylor SF, Cook IA, O’Reardon J, Husain MM, Wall C, Krystal AD, Sampson SM, Morales O, Nelson BG, Latoussakis V, George MS, Lisanby SH. Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. J Clin Psychiatry 2018; 79:16cs10905. [PMID: 28541649 PMCID: PMC5846193 DOI: 10.4088/jcp.16cs10905] [Citation(s) in RCA: 334] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To provide expert recommendations for the safe and effective application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder (MDD). PARTICIPANTS Participants included a group of 17 expert clinicians and researchers with expertise in the clinical application of rTMS, representing both the National Network of Depression Centers (NNDC) rTMS Task Group and the American Psychiatric Association Council on Research (APA CoR) Task Force on Novel Biomarkers and Treatments. EVIDENCE The consensus statement is based on a review of extensive literature from 2 databases (OvidSP MEDLINE and PsycINFO) searched from 1990 through 2016. The search terms included variants of major depressive disorder and transcranial magnetic stimulation. The results were limited to articles written in English that focused on adult populations. Of the approximately 1,500 retrieved studies, a total of 118 publications were included in the consensus statement and were supplemented with expert opinion to achieve consensus recommendations on key issues surrounding the administration of rTMS for MDD in clinical practice settings. CONSENSUS PROCESS In cases in which the research evidence was equivocal or unclear, a consensus decision on how rTMS should be administered was reached by the authors of this article and is denoted in the article as "expert opinion." CONCLUSIONS Multiple randomized controlled trials and published literature have supported the safety and efficacy of rTMS antidepressant therapy. These consensus recommendations, developed by the NNDC rTMS Task Group and APA CoR Task Force on Novel Biomarkers and Treatments, provide comprehensive information for the safe and effective clinical application of rTMS in the treatment of MDD.
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Affiliation(s)
- Shawn M. McClintock
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Corresponding author: Shawn M. McClintock, PhD, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8898 ()
| | - Irving M. Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Linda L. Carpenter
- Butler Hospital, Brown Department of Psychiatry and Human Behavior, Providence, Rhode Island
| | - William M. McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Marc Dubin
- Department of Psychiatry, Weill Cornell Medical College, White Plains, New York
| | | | - Ian A. Cook
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences and of Bioengineering, University of California at Los Angeles, Los Angeles
| | - John O’Reardon
- Department of Psychiatry and Behavioral Sciences, Rowan University School of Medicine, Stratford, New Jersey
| | - Mustafa M. Husain
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Andrew D. Krystal
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco
| | | | - Oscar Morales
- Psychiatric Neurotherapeutics Program, McLean Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brent G. Nelson
- Department of Psychiatry, University of Minnesota, St Louis Park
| | | | - Mark S. George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston,Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Sarah H. Lisanby
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Gellersen HM, Kedzior KK. An Update of a Meta-Analysis on the Clinical Outcomes of Deep Transcranial Magnetic Stimulation (DTMS) in Major Depressive Disorder (MDD). ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract. Deep transcranial magnetic stimulation (DTMS) is a noninvasive therapy for treatment-resistant major depressive disorder (MDD). The current study aimed to update a previous meta-analysis by investigating the acute and longer-term clinical outcomes of DTMS and their possible predictors (patient characteristics and stimulation parameters) in unipolar MDD. A systematic literature search identified 11 studies with 282 treatment-resistant, unipolar MDD patients. The clinical outcomes (depression severity, response and remission rates) were evaluated using random-effects meta-analyses. High frequency and intensity DTMS protocol with H1-coil had significant acute antidepressant outcomes and improved some cognitive functions after 20 daily sessions in unipolar MDD. Response rates tended to increase with lower severity of illness. Antidepressant effects were prolonged if maintenance DTMS was used after daily stimulation phases. DTMS consistently improves various symptom domains (antidepressant, cognitive) in treatment-resistant unipolar MDD.
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Affiliation(s)
- Helena M. Gellersen
- Behavioural and Clinical Neuroscience Institute (BCNI), Department of Psychology, University of Cambridge, UK
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35
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A randomized, sham-controlled study of maintenance rTMS for treatment-resistant depression (TRD). Psychiatry Res 2017; 258:226-233. [PMID: 28844559 DOI: 10.1016/j.psychres.2017.08.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 08/04/2017] [Accepted: 08/13/2017] [Indexed: 12/28/2022]
Abstract
A few open-labeled studies have investigated the use of maintenance rTMS to prevent relapse for treatment-resistant depression (TRD) after rTMS treatment. We aim to assess the benefits of maintenance rTMS treatment for TRD patients who respond to rTMS treatment using a randomized, double-blind controlled design. Fifty eight TRD patients received rTMS over one month in an open-labeled design study (phase I). Responder patients were then randomized into active and sham high-frequency rTMS groups for the subsequent eleven months (phase II). The regularity of sessions was gradually reduced. The antidepressant effect of rTMS was evaluated using the Hamilton Depression Rating Scale (HDRS). Intention-to-treat analysis was performed to assess the effectiveness of maintenance sessions. Of the 58 patients included, 35 patients were responders after one month of active rTMS (phase I), and 17 patients were randomized for the maintenance sessions (phase II). The delta HDRS scores demonstrated a significant improvement between the first month and the fourth month in active group in comparison with sham group (phase II). There was no significant difference between these two groups for other periods of time. Repetitive TMS could represent a novel strategy for preventing relapse in TRD patients who respond to rTMS treatment. These results should be confirmed in a larger sample.
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36
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Tavares DF, Myczkowski ML, Alberto RL, Valiengo L, Rios RM, Gordon P, de Sampaio-Junior B, Klein I, Mansur CG, Marcolin MA, Lafer B, Moreno RA, Gattaz W, Daskalakis ZJ, Brunoni AR. Treatment of Bipolar Depression with Deep TMS: Results from a Double-Blind, Randomized, Parallel Group, Sham-Controlled Clinical Trial. Neuropsychopharmacology 2017; 42:2593-2601. [PMID: 28145409 PMCID: PMC5686495 DOI: 10.1038/npp.2017.26] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 01/27/2017] [Indexed: 12/26/2022]
Abstract
Bipolar depression (BD) is a highly prevalent condition with limited therapeutic options. Deep (H1-coil) transcranial magnetic stimulation (dTMS) is a novel TMS modality with established efficacy for unipolar depression. We conducted a randomized sham-controlled trial to evaluate the efficacy and safety of dTMS in treatment-resistant BD patients. Patients received 20 sessions of active or sham dTMS over the left dorsolateral prefrontal cortex (H1-coil, 55 18 Hz 2 s 120% MT trains). The primary outcome was changes in the 17-item Hamilton Depression Rating Scale (HDRS-17) from baseline to endpoint (week 4). Secondary outcomes were changes from baseline to the end of the follow-up phase (week 8), and response and remission rates. Safety was assessed using a dTMS adverse effects questionnaire and the Young Mania Rating Scale to assess treatment-emergent mania switch (TEMS). Out of 50 patients, 43 finished the trial. There were 2 and 5 dropouts in the sham and active groups, respectively. Active dTMS was superior to sham at end point (difference favoring dTMS=4.88; 95% CI 0.43 to 9.32, p=0.03) but not at follow-up. There was also a trend for greater response rates in the active (48%) vs sham (24%) groups (OR=2.92; 95% CI=0.87 to 9.78, p=0.08). Remission rates were not statistically different. No TEMS episodes were observed. Deep TMS is a potentially effective and well-tolerated add-on therapy in resistant bipolar depressed patients receiving adequate pharmacotherapy.
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Affiliation(s)
- Diego F Tavares
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Martin L Myczkowski
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rodrigo L Alberto
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Leandro Valiengo
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Rosa M Rios
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pedro Gordon
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bernardo de Sampaio-Junior
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
| | - Izio Klein
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
| | - Carlos G Mansur
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Antonio Marcolin
- Department and Institute of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Beny Lafer
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo A Moreno
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Wagner Gattaz
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, Clarke Division, Toronto, Ontario, Canada
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
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Voigt J, Carpenter L, Leuchter A. Cost effectiveness analysis comparing repetitive transcranial magnetic stimulation to antidepressant medications after a first treatment failure for major depressive disorder in newly diagnosed patients - A lifetime analysis. PLoS One 2017; 12:e0186950. [PMID: 29073256 PMCID: PMC5658110 DOI: 10.1371/journal.pone.0186950] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/10/2017] [Indexed: 12/15/2022] Open
Abstract
Objective Repetitive Transcranial Magnetic Stimulation (rTMS) commonly is used for the treatment of Major Depressive Disorder (MDD) after patients have failed to benefit from trials of multiple antidepressant medications. No analysis to date has examined the cost-effectiveness of rTMS used earlier in the course of treatment and over a patients’ lifetime. Methods We used lifetime Markov simulation modeling to compare the direct costs and quality adjusted life years (QALYs) of rTMS and medication therapy in patients with newly diagnosed MDD (ages 20–59) who had failed to benefit from one pharmacotherapy trial. Patients’ life expectancies, rates of response and remission, and quality of life outcomes were derived from the literature, and treatment costs were based upon published Medicare reimbursement data. Baseline costs, aggregate per year quality of life assessments (QALYs), Monte Carlo simulation, tornado analysis, assessment of dominance, and one way sensitivity analysis were also performed. The discount rate applied was 3%. Results Lifetime direct treatment costs, and QALYs identified rTMS as the dominant therapy compared to antidepressant medications (i.e., lower costs with better outcomes) in all age ranges, with costs/improved QALYs ranging from $2,952/0.32 (older patients) to $11,140/0.43 (younger patients). One-way sensitivity analysis demonstrated that the model was most sensitive to the input variables of cost per rTMS session, monthly prescription drug cost, and the number of rTMS sessions per year. Conclusion rTMS was identified as the dominant therapy compared to antidepressant medication trials over the life of the patient across the lifespan of adults with MDD, given current costs of treatment. These models support the use of rTMS after a single failed antidepressant medication trial versus further attempts at medication treatment in adults with MDD.
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Affiliation(s)
- Jeffrey Voigt
- Medical Device Consultants of Ridgewood, LLC, Ridgewood, NJ, United States of America
- * E-mail:
| | - Linda Carpenter
- Department of Psychiatry and Human Behavior, Brown Institute for Brain Science, Brown University, Providence, RI, United States of America
| | - Andrew Leuchter
- Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University California Los Angeles, Los Angeles, CA, United States of America
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38
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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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Kedzior KK, Schuchinsky M, Gerkensmeier I, Loo C. Challenges in comparing the acute cognitive outcomes of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) vs. electroconvulsive therapy (ECT) in major depression: A systematic review. J Psychiatr Res 2017; 91:14-17. [PMID: 28288306 DOI: 10.1016/j.jpsychires.2017.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/08/2017] [Accepted: 03/01/2017] [Indexed: 01/21/2023]
Abstract
The present study aimed to systematically compare the cognitive outcomes of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and electroconvulsive therapy (ECT) in head-to-head studies with major depression (MDD) patients. A systematic literature search identified six studies with 219 MDD patients that were too heterogeneous to reliably detect meaningful differences in acute cognitive outcomes after ECT vs. HF-rTMS. Cognitive effects of brain stimulation vary depending on the timeframe and methods of assessment, stimulation parameters, and maintenance treatment. Thus, acute and longer-term differences in cognitive outcomes both need to be investigated at precisely defined timeframes and with similar instruments assessing comparable functions.
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Affiliation(s)
| | | | | | - Colleen Loo
- University of New South Wales, Black Dog Institute, St. George Hospital, Australia
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40
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Berlim MT, McGirr A, Rodrigues Dos Santos N, Tremblay S, Martins R. Efficacy of theta burst stimulation (TBS) for major depression: An exploratory meta-analysis of randomized and sham-controlled trials. J Psychiatr Res 2017; 90:102-109. [PMID: 28254709 DOI: 10.1016/j.jpsychires.2017.02.015] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/14/2017] [Accepted: 02/17/2017] [Indexed: 01/08/2023]
Abstract
Theta burst stimulation (TBS) has been proposed as a novel treatment for major depression (MD). However, randomized and sham-controlled trials (RCTs) published to date have yielded heterogeneous clinical results and we have thus carried out the present systematic review and exploratory meta-analysis of RCTs to evaluate this issue. We searched the literature for RCTs on TBS for MD from January 2001 through September 2016 using MEDLINE, EMBASE, PsycINFO, and CENTRAL. We then performed a random-effects meta-analysis with the main outcome measures including pre-post score changes in the Hamilton Depression Rating Scale (HAM-D) as well as rates of response, remission and dropout. Data were obtained from 5 RCTs, totalling 221 subjects with MD. The pooled Hedges' g for pre-post change in HAM-D scores was 1.0 (p = 0.003), indicating a significant and large-sized difference in outcome favouring active TBS. Furthermore, active TBS was associated with significantly higher response rates when compared to sham TBS (35.6% vs. 17.5%, respectively; p = 0.005), although the groups did not differ in terms of rates of remission (18.6% vs. 10.7%, respectively; p = 0.1) and dropout (4.2% vs. 7.8%, respectively; p = 0.5). Finally, subgroup analyses indicated that bilateral TBS and unilateral intermittent TBS seem to be the most promising protocols. In conclusion, although TBS is a promising novel therapeutic intervention for MD, future studies should identify more clinically-relevant stimulation parameters as well as neurobiological predictors of treatment outcome, and include larger sample sizes, active comparators and longer follow-up periods.
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Affiliation(s)
- Marcelo T Berlim
- Neuromodulation Research Clinic, Douglas Institute and McGill University, Montréal, Québec, Canada; Depressive Disorders Program, Douglas Institute and McGill University, Montréal, Québec, Canada.
| | - Alexander McGirr
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sara Tremblay
- Neuromodulation Research Clinic, Douglas Institute and McGill University, Montréal, Québec, Canada; Institute of Neurology, University College London, London, United Kingdom
| | - Ruben Martins
- Neuromodulation Research Clinic, Douglas Institute and McGill University, Montréal, Québec, Canada
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Magavi LR, Reti IM, Vasa RA. A review of repetitive transcranial magnetic stimulation for adolescents with treatment-resistant depression. Int Rev Psychiatry 2017; 29:79-88. [PMID: 28306351 DOI: 10.1080/09540261.2017.1300574] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This review examines the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) as a treatment for treatment-resistant depression in adolescents. A systematic review of six databases was conducted. Ten multi-subject trials, all uncontrolled, and five case reports met inclusion criteria. Twelve studies focused on treatment efficacy, whereas three studies focused exclusively on adverse events. All efficacy studies focused on adolescents only; 10 of these studies indicated that rTMS may demonstrate some benefit. Improvement within 2-8 weeks was reported in most studies, with a few studies indicating potential long-term benefits. A variety of adverse events occurred including scalp pain, which was the most common, as well as seizures. Controlled studies of rTMS are warranted to further examine whether this treatment is a potential option for adolescents with treatment-resistant depression.
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Affiliation(s)
| | | | - Roma A Vasa
- a Johns Hopkins Hospital , Baltimore , MD , USA
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Dubin MJ, Liston C, Avissar MA, Ilieva I, Gunning FM. Network-Guided Transcranial Magnetic Stimulation for Depression. Curr Behav Neurosci Rep 2017; 4:70-77. [PMID: 28316903 DOI: 10.1007/s40473-017-0108-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW First, we will identify candidate predictive biomarkers of antidepressant response of TMS based on the neuroimaging literature. Next, we will review the effects of TMS on networks involved in depression. Finally, we will discuss ways in which our current understanding of network engagement by TMS may be used to optimize its antidepressant effect. RECENT FINDINGS The past few years has seen significant interest in the antidepressant mechanisms of TMS. Studies using functional neuroimaging and neurochemical imaging have demonstrated engagement of networks known to be important in depression. Current evidence supports a model whereby TMS normalizes network function gradually over the course of several treatments. This may, in turn, mediate its antidepressant effect. SUMMARY One strategy to optimize the antidepressant effect of TMS is to more precisely target networks relevant in depression. We propose methods to achieve this using functional and neurochemical imaging.
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Affiliation(s)
- Marc J Dubin
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, 10065, USA; Feil Family Mind and Brain Institute, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, 10065, USA; Feil Family Mind and Brain Institute, Weill Cornell Medical College, New York, NY, 10065, USA; Sackler Institute for Developmental Psychobiology, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Michael A Avissar
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA; Division of Experimental Therapeutics, New York State Psychiatric Institute
| | - Irena Ilieva
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, 10065, USA; Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, 10065, USA; Institute of Geriatric Psychiatry, Weill Cornell Medical College, New York, NY, 10065, USA
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Teng S, Guo Z, Peng H, Xing G, Chen H, He B, McClure M, Mu Q. High-frequency repetitive transcranial magnetic stimulation over the left DLPFC for major depression: Session-dependent efficacy: A meta-analysis. Eur Psychiatry 2017; 41:75-84. [DOI: 10.1016/j.eurpsy.2016.11.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 01/18/2023] Open
Abstract
AbstractBackgroundDepression is a major debilitating psychiatric disorder. Current antidepressant drugs are often associated with side effects or treatment resistance. The aim of this meta-analysis was to evaluate therapeutic effects of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in major depression (MD).MethodsThe medical data bases of PubMed, Medline, Embase and Cochrane Central Register were searched for randomized controlled trials (RCTs) reporting the therapeutic effects of high-frequency rTMS for depression, which were published in English between January 1990 and June 2016. The index terms were “depress*”, “depression” and “transcranial magnetic stimulation”. Depression outcome data of different sessions (5, 10, 15, and 20 sessions of rTMS treatment) were extracted and synthesized by calculating standardized mean difference (SMD) with 95% confidence intervals (CI) by using a random-effect model. Within each session group, the subgroup analyses based on the number of pulses (≤ 1000, 1200–1500, 1600–1800, and 2000–3000) were also conducted.ResultsThirty RCTs with a total of 1754 subjects including 1136 in the rTMS group and 618 in the sham group were included in this meta-analysis. rTMS had a significant overall therapeutic effect on depression severity scores (SMD = −0.73, P < 0.00001). The five, 10, 15, 20 sessions of rTMS treatments yielded the significant mean effect sizes of −0.43, −0.60, −1.13, and −2.74, respectively. In the four groups (5, 10, 15, 20 sessions), the maximal mean effect size was all obtained in the subgroup of 1200–1500 pulses per day (−0.97, −1.14, −1.91, −5.47; P < 0.05).ConclusionsThe increasing of HF-rTMS sessions is associated with the increased efficacy of HF-rTMS in reducing depressed patients’ symptom severity. A total number of pulses of 1200–1500 per day appear to deliver the best antidepressant effects of HF-rTMS.
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Becker JE, Maley C, Shultz E, Taylor WD. Update on Transcranial Magnetic Stimulation for Depression and Other Neuropsychiatric Illnesses. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20160930-01] [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: 11/20/2022]
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Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ, Downar J, Modirrousta M, Patry S, Vila-Rodriguez F, Lam RW, MacQueen GM, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 4. Neurostimulation Treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:561-75. [PMID: 27486154 PMCID: PMC4994792 DOI: 10.1177/0706743716660033] [Citation(s) in RCA: 368] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Neurostimulation Treatments" is the fourth of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 31 questions for 6 neurostimulation modalities: 1) transcranial direct current stimulation (tDCS), 2) repetitive transcranial magnetic stimulation (rTMS), 3) electroconvulsive therapy (ECT), 4) magnetic seizure therapy (MST), 5) vagus nerve stimulation (VNS), and 6) deep brain stimulation (DBS). Most of the neurostimulation treatments have been investigated in patients with varying degrees of treatment resistance. CONCLUSIONS There is increasing evidence for efficacy, tolerability, and safety of neurostimulation treatments. rTMS is now a first-line recommendation for patients with MDD who have failed at least 1 antidepressant. ECT remains a second-line treatment for patients with treatment-resistant depression, although in some situations, it may be considered first line. Third-line recommendations include tDCS and VNS. MST and DBS are still considered investigational treatments.
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Affiliation(s)
- Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Simon Patry
- Department of Psychiatry, L'Université Laval, Québec City, Québec
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Ljubisavljevic M, Maxood K, Bjekic J, Oommen J, Nagelkerke N. Long-Term Effects of Repeated Prefrontal Cortex Transcranial Direct Current Stimulation (tDCS) on Food Craving in Normal and Overweight Young Adults. Brain Stimul 2016; 9:826-833. [PMID: 27498606 DOI: 10.1016/j.brs.2016.07.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 06/28/2016] [Accepted: 07/09/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The dorsolateral prefrontal cortex (DLPFC) plays an important role in the regulation of food intake. Several previous studies demonstrated that a single session of transcranial direct current stimulation (tDCS) of the DLPFC reduces food craving and caloric intake. OBJECTIVES We hypothesized that repeated tDCS of the right DLPFC cortex may exert long-term changes in food craving in young, healthy adults and that these changes may differ between normal and overweight subjects. METHODS Thirty healthy individuals who reported frequent food cravings without a prior history of eating disorders were initially recruited. Subjects were randomized into an ACTIVE group who received 5 days of real tDCS (20 minutes, anode right-cathode left montage, 2 mA with current density kept at 0.06 mA/cm2, 1 min ramp-up/ramp-down), and a SHAM group, who received one day of real tDCS, on the first day (same parameters), followed by 4 days of sham tDCS. Food craving intensity was examined by Food Craving Questionnaires State and Trait and Food Craving Inventory before, during, (5-days) and one month (30-days) after tDCS. RESULTS Single session of tDCS significantly reduced the intensity of current food craving (FCQ-S). Five days of active tDCS significantly reduced habitual experiences of food craving (FCQ-T), when compared to baseline pre-stimulation levels. Furthermore, both current (FCQ-S) and habitual craving (FCQ-T) were significantly reduced 30 days after active tDCS, while sham tDCS, i.e. a single tDCS session did not have significant effects. Also, active tDCS significantly decreased craving for fast food and sweets, and to a lesser degree for fat, while it did not have significant effects on craving for carbohydrates (FCI). There were no significant differences between individual FCQ-T subscales (craving dimensions) after 5 or 30 days of either sham or active tDCS. Changes in craving were not significantly associated with the initial weight, or with weight changes 30 days after the stimulation in the subjects. CONCLUSIONS The results confirm earlier findings that single session of tDCS has immediate effects in reducing food craving. They also show that repeated tDCS over the right DLPFC may increase the duration of its effects, which may be present 30 days after the stimulation. These results support further investigation of the use of tDCS in obesity.
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Affiliation(s)
- M Ljubisavljevic
- Department of Physiology, College of Medicine and Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates.
| | - K Maxood
- Department of Physiology, College of Medicine and Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates
| | - J Bjekic
- Department of Neurophysiology, Institute for Medical Research, University of Belgrade, PO Box 124, Belgrade, Serbia
| | - J Oommen
- Department of Physiology, College of Medicine and Health Sciences, UAE University, PO Box 17666, Al Ain, United Arab Emirates
| | - N Nagelkerke
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Queen Elizabeth Central Hospital, Malawi; Institute of Public Health, College of Medicine and Health Sciences, PO Box 17666, UAE University, Al Ain, United Arab Emirates
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Kedzior KK, Gierke L, Gellersen HM, Berlim MT. Cognitive functioning and deep transcranial magnetic stimulation (DTMS) in major psychiatric disorders: A systematic review. J Psychiatr Res 2016; 75:107-15. [PMID: 26828370 DOI: 10.1016/j.jpsychires.2015.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
Abstract
Deep transcranial magnetic stimulation (DTMS) is a non-invasive brain stimulation method mostly utilised in the treatment of major depression. The aim of the current study was to systematically review the literature on the cognitive effects of DTMS applied with the H-coil system in major psychiatric disorders. Following a literature search in PsycInfo and PubMed (any time to December 2015), 13 out of 32 studies on DTMS and cognitive functioning were included in the current review. Three studies included 38 healthy participants, eight studies included 158 unipolar or bipolar depression patients and two studies included 45 schizophrenia patients. Low-frequency DTMS (1-3 sessions) had little effect on cognitive functioning in healthy participants. The most consistent cognitive and clinical improvements were reported in the short-term (after 20 daily sessions of high-frequency DTMS with H1-coil) in studies with major depression patients. There was also a trend towards a short-term cognitive and clinical improvement in studies with schizophrenia patients. High-frequency DTMS might improve cognitive functioning and alleviate clinical symptoms in the short-term, particularly in major depression. However, this conclusion is based on data from mostly uncontrolled, open-label studies with patients receiving concurrent antidepressants or antipsychotics. Randomised, sham-controlled trials are needed to investigate the magnitude of the cognitive outcomes of DTMS in the short-term and beyond the daily stimulation phase in major psychiatric disorders.
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Affiliation(s)
| | - Lioba Gierke
- Institute of Psychology and Transfer, University of Bremen, Bremen, Germany
| | | | - Marcelo T Berlim
- Department of Psychiatry, McGill University, and Neuromodulation Research Clinic, Douglas Institute, Montreal, Canada
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Kedzior KK, Gellersen HM, Brachetti AK, Berlim MT. Deep transcranial magnetic stimulation (DTMS) in the treatment of major depression: An exploratory systematic review and meta-analysis. J Affect Disord 2015; 187:73-83. [PMID: 26321258 DOI: 10.1016/j.jad.2015.08.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/30/2015] [Accepted: 08/12/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Deep transcranial magnetic stimulation (DTMS) is a relatively new, non-invasive method of stimulating larger and, presumably, deeper brain regions. The current study investigated if DTMS delivered with H-coils has acute antidepressant effects in major depression using a systematic literature review and a quantitative meta-analysis. METHODS Seventeen studies on 'DTMS or H-coil' and 'depression' were identified on Medline, PsycInfo, and Google Scholar (until November 2014). Data from nine open-label studies were meta-analysed using a random-effects model with inverse-variance weights. The outcome measures were the standardised paired mean difference (Cohen's d) in depression scores on Hamilton Depression Rating Scale (HDRS), response, remission, and dropout rates after acute DTMS treatment compared to baseline. RESULTS There was a large antidepressant effect after 20 acute, high-frequency DTMS sessions compared to baseline according to HDRS change scores (overall mean weighted d=2.04, 95% confidence interval: 1.53-2.55; nine studies; 150 patients). Overall weighted response, remission, and dropout rates were 60%, 29%, and 18% respectively. HDRS change scores and response rates tended to be higher in four studies with 68 patients on concurrent antidepressants compared to two studies with 26 patients who received DTMS as a monotherapy. LIMITATIONS These results are based on data from a low number of open-label studies. CONCLUSION High-frequency DTMS appears to have acute antidepressant effects after 20 sessions in mostly unipolar and treatment-resistant patients. Concurrent treatment with antidepressants might enhance the efficacy of DTMS.
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Affiliation(s)
- Karina Karolina Kedzior
- Institute of Psychology and Transfer, University of Bremen, Grazer Straße 2c, 28359 Bremen, Germany.
| | | | | | - Marcelo T Berlim
- Department of Psychiatry, McGill University, and Neuromodulation Research Clinic, Douglas Institute, Montreal, Canada
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