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Morriss R, Briley PM, Webster L, Abdelghani M, Barber S, Bates P, Brookes C, Hall B, Ingram L, Kurkar M, Lankappa S, Liddle PF, McAllister-Williams RH, O'Neil-Kerr A, Pszczolkowski S, Suazo Di Paola A, Walters Y, Auer DP. Connectivity-guided intermittent theta burst versus repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled trial. Nat Med 2024; 30:403-413. [PMID: 38228914 PMCID: PMC10878976 DOI: 10.1038/s41591-023-02764-z] [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: 06/29/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024]
Abstract
Disruption in reciprocal connectivity between the right anterior insula and the left dorsolateral prefrontal cortex is associated with depression and may be a target for neuromodulation. In a five-center, parallel, double-blind, randomized controlled trial we personalized resting-state functional magnetic resonance imaging neuronavigated connectivity-guided intermittent theta burst stimulation (cgiTBS) at a site based on effective connectivity from the right anterior insula to the left dorsolateral prefrontal cortex. We tested its efficacy in reducing the primary outcome depression symptoms measured by the GRID Hamilton Depression Rating Scale 17-item over 8, 16 and 26 weeks, compared with structural magnetic resonance imaging (MRI) neuronavigated repetitive transcranial magnetic stimulation (rTMS) delivered at the standard stimulation site (F3) in patients with 'treatment-resistant depression'. Participants were randomly assigned to 20 sessions over 4-6 weeks of either cgiTBS (n = 128) or rTMS (n = 127) with resting-state functional MRI at baseline and 16 weeks. Persistent decreases in depressive symptoms were seen over 26 weeks, with no differences between arms on the primary outcome GRID Hamilton Depression Rating Scale 17-item score (intention-to-treat adjusted mean, -0.31, 95% confidence interval (CI) -1.87, 1.24, P = 0.689). Two serious adverse events were possibly related to TMS (mania and psychosis). MRI-neuronavigated cgiTBS and rTMS were equally effective in patients with treatment-resistant depression over 26 weeks (trial registration no. ISRCTN19674644).
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Affiliation(s)
- Richard Morriss
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Paul M Briley
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Webster
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Mohamed Abdelghani
- Clinical Neuromodulation Service, Camden and Islington NHS Foundation Trust, London, UK
| | - Shaun Barber
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Peter Bates
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Cassandra Brookes
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Beth Hall
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Luke Ingram
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Micheal Kurkar
- Pennine Care TMS Service, Pennine Care NHS Foundation Trust, Oldham, UK
| | - Sudheer Lankappa
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Peter F Liddle
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - R Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alexander O'Neil-Kerr
- Centre for Neuromodulation, Northamptonshire Healthcare NHS Foundation Trust, Northampton, UK
| | - Stefan Pszczolkowski
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Yvette Walters
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Dorothee P Auer
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
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