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Mollica A, Ng E, Burke MJ, Nestor SM, Lee H, Rabin JS, Hamani C, Lipsman N, Giacobbe P. Treatment expectations and clinical outcomes following repetitive transcranial magnetic stimulation for treatment-resistant depression. Brain Stimul 2024; 17:752-759. [PMID: 38901565 DOI: 10.1016/j.brs.2024.06.006] [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: 12/20/2023] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Patient expectations, including both positive (placebo) and negative (nocebo) effects, influence treatment outcomes, yet their impact on acute repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression (TRD) is unclear. METHODS In this single-center retrospective chart review, 208 TRD patients completed the Stanford Expectation of Treatment Scale (SETS) before starting open-label rTMS treatment. Patients were offered two excitatory rTMS protocols (deep TMS or intermittent theta-burst stimulation), which stimulated the left dorsolateral prefrontal cortex. A minimum of 20 once daily treatments were provided, delivered over 4-6 weeks. Primary outcomes were 1) remission, measured by a post-treatment score of <8 on the Hamilton Depression Rating Scale (HAMD-17), and 2) premature discontinuation. The change in HAMD-17 scores over time was used as a secondary outcome. Physicians were blinded to SETS scores. Logistic and linear regression, adjusting for covariates, assessed SETS and HAMD-17 relationships. RESULTS Of 208 patients, 177 had baseline and covariate data available. The mean positivity bias score (positive expectancy minus negative expectancy subscale averages) was 0.48 ± 2.21, indicating the cohort was neutral regarding the expectations of their treatment on average. Higher positive expectancy scores were significantly associated with greater odds of remission (OR = 1.90, p = 0.003) and greater reduction in HAMD-17 scores (β = 1.30, p = 0.005) at the end of acute treatment, after adjusting for covariates. Negative expectancy was not associated with decreased odds of remission (p = 0.2) or treatment discontinuation (p = 0.8). CONCLUSIONS Higher pre-treatment positive expectations were associated with greater remission rates with open-label rTMS in a naturalistic cohort of patients with TRD.
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Affiliation(s)
- Adriano Mollica
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Enoch Ng
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Matthew J Burke
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sean M Nestor
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Hyewon Lee
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, University of Toronto, Canada
| | - Clement Hamani
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Peter Giacobbe
- Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada; Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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Lan XJ, Yang XH, Mo Y, Deng CJ, Huang XB, Cai DB, Zheng W. Deep transcranial magnetic stimulation for treatment-resistant depression: A systematic review and meta-analysis of randomized controlled studies. Asian J Psychiatr 2024; 96:104032. [PMID: 38574492 DOI: 10.1016/j.ajp.2024.104032] [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: 12/07/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
The efficacy and safety of deep transcranial magnetic stimulation (dTMS) in treating treatment-resistant depression (TRD) are unknown. Up to June 21, 2023, we conducted a systematic search for RCTs, and then extracted and synthesized data using random effects models. Five RCTs involving 507 patients with TRD (243 in the active dTMS group and 264 in the control group) were included in the present study. The active dTMS group showed significantly higher study-defined response rate (45.3% versus 24.2%, n = 507, risk ratio [RR] = 1.87, 95% confidence interval [CI]: 1.21-2.91, I2 = 53%; P = 0.005) and study-defined remission rate (38.3% versus 14.4%, n = 507, RR = 2.37, 95%CI: 1.30-4.32, I2 = 58%; P = 0.005) and superiority in improving depressive symptoms (n = 507, standardized mean difference = -0.65, 95%CI: -1.11--0.18, I2 = 82%; P = 0.006) than the control group. In terms of cognitive functions, no significant differences were observed between the two groups. The two groups also showed similar rates of other adverse events and all-cause discontinuations (P > 0.05). dTMS is an effective and safe treatment strategy for the management of patients with TRD.
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Affiliation(s)
- Xian-Jun Lan
- The Brain Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Xin-Hu Yang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yu Mo
- The Brain Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Can-Jin Deng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xing-Bing Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Dong-Bin Cai
- Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China.
| | - Wei Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Mo Y, Shi ZM, Yang XH, Lan XJ, Deng CJ, Huang XB, Tan XL, Pridmore S, Ungvari GS, Xiang YT, Zheng W. Deep transcranial magnetic stimulation for schizophrenia: a systematic review. Front Psychiatry 2024; 15:1390913. [PMID: 38881546 PMCID: PMC11176548 DOI: 10.3389/fpsyt.2024.1390913] [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: 02/24/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Background The efficacy and safety of deep transcranial magnetic stimulation (dTMS) as an intervention for schizophrenia remain unclear. This systematic review examined the efficacy and safety of dTMS for schizophrenia. Methods A systematic search of Chinese (WanFang and Chinese Journal Net) and English databases (PubMed, EMBASE, PsycINFO, and Cochrane Library) were conducted. Results Three randomized clinical trials (RCTs) comprising 80 patients were included in the analyses. Active dTMS was comparable to the sham treatment in improving total psychopathology, positive symptoms, negative symptoms, and auditory hallucinations measured by the Positive and Negative Syndrome Scale (PANSS), the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Auditory Hallucinations Rating Scale (AHRS), respectively. Only one RCT reported the effects on neurocognitive function measured by the Cambridge Neuropsychological Test Automated Battery (CANTAB), suggesting that dTMS may only improve one Stockings of Cambridge measure (i.e., subsequent times for five move problems). All three studies reported overall discontinuation rates, which ranged from 16.7% to 44.4%. Adverse events were reported in only one RCT, the most common being tingling/twitching (30.0%, 3/10), head/facial discomfort (30.0%, 3/10), and back pain (20.0%, 2/10). Conclusion This systematic review suggests that dTMS does not reduce psychotic symptoms in schizophrenia, but it shows potential for improving executive functions. Future RCTs with larger sample sizes focusing on the effects of dTMS on psychotic symptoms and neurocognitive function in schizophrenia are warranted to further explore these findings.
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Affiliation(s)
- Yu Mo
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Zhan-Ming Shi
- Department of Psychiatry, Chongqing Jiangbei Second Hospital, Chongqing, China
| | - Xin-Hu Yang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xian-Jun Lan
- Department of Psychiatry, The Brain Hospital of Guangxi Zhuang Autonomous Region, LiuZhou, China
| | - Can-Jin Deng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xing-Bing Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xiao-Lin Tan
- Department of Psychiatry, Chongqing mental health center, Chongqing, China
| | - Saxby Pridmore
- Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - Gabor S Ungvari
- Section of Psychiatry, University of Notre Dame Australia, Fremantle, WA, Australia
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Wei Zheng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
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Bahun I, Ivezic E, Đogas VV, Filipcic IS, Filipcic I. A pilot study of accelerated deep transcranial magnetic stimulation effects on cognitive functioning in patients diagnosed with treatment resistant major depressive disorder. Psychiatry Res 2022; 316:114750. [PMID: 35944371 DOI: 10.1016/j.psychres.2022.114750] [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: 01/10/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to assess cognitive functioning in patients diagnosed with major depressive disorder (MDD) treated with two different accelerated deep transcranial magnetic stimulation (dTMS) modalities as an add-on to stable pharmacotherapy.A total of 32 adult psychiatric inpatients diagnosed with treatment resistant MDD were allocated by stratified randomization into two groups: a group treated with dTMS twice a day during 2 weeks, and a group treated with dTMS twice a day during 3 weeks. Clinical psychologists assessed participants´ cognitive functions (memory, visuospatial functioning, executive functions, psychomotor speed, verbal fluency) via a battery of instruments, after the inclusion, and by the end of treatment.Our findings showed mild to moderate improvements in the majority of administered tests measuring different cognitive functions, meaning that patients achieved significantly better results by the end of the treatment compared to baseline, regardless of the duration of the treatment (2 or 3 weeks). No adverse effects on cognition were observed. The results seem promising in the context of treating the cognitive symptoms associated with functional recovery of patients suffering from depression.
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Affiliation(s)
- Ivana Bahun
- University Psychiatric Clinic Sveti Ivan, Jankomir 11, Zagreb 10090, Croatia
| | - Ena Ivezic
- University Psychiatric Clinic Sveti Ivan, Jankomir 11, Zagreb 10090, Croatia; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.
| | | | - Ivona Simunovic Filipcic
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Igor Filipcic
- University Psychiatric Clinic Sveti Ivan, Jankomir 11, Zagreb 10090, Croatia; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
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Marder KG, Barbour T, Ferber S, Idowu O, Itzkoff A. Psychiatric Applications of Repetitive Transcranial Magnetic Stimulation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:8-18. [PMID: 35746935 PMCID: PMC9063593 DOI: 10.1176/appi.focus.20210021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Transcranial magnetic stimulation (TMS) is an increasingly popular noninvasive brain stimulation modality. In TMS, a pulsed magnetic field is used to noninvasively stimulate a targeted brain region. Repeated stimulation produces lasting changes in brain activity via mechanisms of synaptic plasticity similar to long-term potentiation. Local application of TMS alters activity in distant, functionally connected brain regions, indicating that TMS modulates activity of cortical networks. TMS has been approved by the U.S. Food and Drug Administration for the treatment of major depressive disorder, obsessive-compulsive disorder, and smoking cessation, and a growing evidence base supports its efficacy in the treatment of other neuropsychiatric conditions. TMS is rapidly becoming part of the standard of care for treatment-resistant depression, where it yields response rates of 40%-60%. TMS is generally safe and well tolerated; its most serious risk is seizure, which occurs very rarely. This review aims to familiarize practicing psychiatrists with basic principles of TMS, including target localization, commonly used treatment protocols and their outcomes, and safety and tolerability. Practical considerations, including evaluation and monitoring of patients undergoing TMS, device selection, treatment setting, and insurance reimbursement, are also reviewed.
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Matsuda Y, Kito S, Igarashi Y, Shigeta M. Efficacy and Safety of Deep Transcranial Magnetic Stimulation in Office Workers with Treatment-Resistant Depression: A Randomized, Double-Blind, Sham-Controlled Trial. Neuropsychobiology 2021; 79:208-213. [PMID: 31955155 DOI: 10.1159/000505405] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/11/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Major depression is a highly prevalent disorder that causes economic burden in office workers. We conducted a randomized, double-blind, sham-controlled trial to evaluate the efficacy and safety of deep transcranial magnetic stimulation (dTMS) in office workers with treatment-resistant depression. METHODS In this study, we randomized office workers taking administrative leave for treatment-resistant major depressive disorder or bipolar disorder with current major depressive episode. dTMS treatment was applied at 120% resting motor threshold with 18 Hz over the left dorsolateral prefrontal cortex. The treatment sessions delivered a total of 1,980 pulses a day, 5 days a week, for 4-6 weeks. The primary outcome was change in the total score on the 21-item Hamilton Depression Rating Scale (HDRS-21) from baseline to the end of study in an intent-to-treat analysis. The secondary outcomes were the response and remission rates. We also assessed changes in cognitive function and adverse events. RESULTS Forty patients were randomized to active or sham dTMS groups (1:1). The change in the total score on the HDRS-21 was more significantly improved in the active group than in the sham group at 6 weeks (p = 0.045). There were no significant differences in the response and remission rates or cognitive measures between the active and sham groups. No serious adverse events were observed in either group. CONCLUSIONS These results suggest that dTMS might be effective and safe in office workers with treatment-resistant depression. Further well-designed studies are needed.
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Affiliation(s)
- Yuki Matsuda
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan,
| | - Shinsuke Kito
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshio Igarashi
- Department of Psychiatry, Medical Care Toranomon Clinic, Tokyo, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
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Hung YY, Yang LH, Stubbs B, Li DJ, Tseng PT, Yeh TC, Chen TY, Liang CS, Chu CS. Efficacy and tolerability of deep transcranial magnetic stimulation for treatment-resistant depression: A systematic review and meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2020; 99:109850. [PMID: 31863873 DOI: 10.1016/j.pnpbp.2019.109850] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/24/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study aimed to investigate the efficacy of deep transcranial magnetic stimulation (dTMS) for treatment-resistant depression (TRD). METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Medline, PsycINFO, Embase, and Cochrane Library were systematically searched from the time of their inception until July 17, 2019. Data were pooled using a random-effects model. Primary outcomes were mean change of depression and anxiety severity. Secondary outcomes were response and remission rate of depression. RESULTS Fifteen studies including three randomized controlled trials (RCTs) (n = 417, mean age: 50.6 years) and twelve uncontrolled clinical trials (n = 284, mean age: 46.4 years) were included. dTMS significantly improved the depressive (Hedges' g = -1.323, 95% CI = -1.651 to -0.995, p < .001) and anxiety symptoms (Hedges' g = -1.282, 95% CI = -1.514 to -1.051, p < .001) in patients with TRD. Subgroup analysis showed that non-RCTs had a larger effect size than RCTs (-1.461 vs -0.756) on depression severity. Although the response and remission rates of the dTMS group were high, only studies using both dTMS and antidepressant medications achieved significance. The anxiolytic effect of dTMS was more heterogeneous, and the results were obtained mainly from non-RCTs. Importantly, the dTMS group showed favorable tolerability without major adverse events. CONCLUSIONS dTMS is a safe and effective intervention in patients with TRD. Studies combining dTMS and antidepressant medications seemed to show greater therapeutic effects. Future studies are needed to address the interaction effect of dTMS with different classes of antidepressant medications.
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Affiliation(s)
- Yu-Yung Hung
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Li-Heng Yang
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Bredon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, UK; Positive Ageing Research Institute (PARI), Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Dian-Jeng Li
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan
| | - Ping-Tao Tseng
- WinShine Clinics in Specialty of Psychiatry, Kaohsiung City, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.
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Factors associated with response after deep transcranial magnetic stimulation in a real-world clinical setting: Results from the first 40 cases of treatment-resistant depression. Eur Psychiatry 2020; 44:61-67. [DOI: 10.1016/j.eurpsy.2017.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 01/04/2023] Open
Abstract
AbstractBackground:Deep transcranial magnetic stimulation (dTMS) has been sanctioned by the United States Food and Drug Administration for treatment-resistant depression. In a retrospective cohort study, we evaluated response and effectiveness of dTMS in real-world practice, as an add-on treatment for resistant depression.Methods:Forty adult outpatients suffering from depression, all taking psychiatric medications, underwent 20 dTMS treatments over a 4–6 week period. At baseline (T0), visit 10 (T1), and visit 20 (T2), the Clinical Global Impression-Severity (CGI-S) scale was administered, and the Clinical Global Impression Improvement (CGI-I) scale was completed at T1 and T2; the Hamilton Depression Rating Scale (HDRS-21) was administrated at T0 and T2 only. The patients also completed the Quick Inventory of Depressive Symptoms–Self-Report (QIDS-SR) at T0, T1, and T2.Results:Depressive symptoms (HDRS-21 total score) decreased significantly following treatment. The HDRS total score decreased from an average of 21.22 (± 6.09) at T0, to 13.95 (± 7.24) at T2. Correspondingly, at T2, 32.5% were responders to the treatment and 20% were in remission, based on the HDRS-21. Treatment was well tolerated, with a discontinuation rate of 7.5%. While depressive symptoms at baseline did not predict remission/response at T2, higher HDRS scores at T0 were associated with a larger decrease in depressive symptoms during the study.Conclusions:Significant antidepressant effects were seen following 20 dTMS treatments, given as augmentation to ongoing medications in treatment-resistant depression. The findings suggest that among patients with TRD, the severity of the depressive episode (and not necessarily the number of failed antidepressant medication trials) is associated with a positive therapeutic effect of dTMS. Hence, the initial severity of the depressive episode may guide clinicians in referring patients for dTMS.
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Filipčić I, Šimunović Filipčić I, Milovac Ž, Sučić S, Gajšak T, Ivezić E, Bašić S, Bajić Ž, Heilig M. Efficacy of repetitive transcranial magnetic stimulation using a figure-8-coil or an H1-Coil in treatment of major depressive disorder; A randomized clinical trial. J Psychiatr Res 2019; 114:113-119. [PMID: 31059991 DOI: 10.1016/j.jpsychires.2019.04.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/21/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment option for major depressive disorder (MDD). However, comparisons of efficacy between the two FDA-approved protocols of rTMS modalities are lacking. The aim of this industry-independent, randomized-controlled, single-blind trial was to evaluate clinical outcome of the two FDA-approved rTMS protocols delivered by H1-coil and the figure-8-coil, in MDD patients. A total of 228 MDD patients were randomized to 20 sessions of H1-coil or 8-coil as an adjunct to standard-of-care pharmacotherapy, or standard-of-care pharmacotherapy alone. Baseline MDD symptom severity was almost the same in the three groups. Hamilton depression rating scale (HAM-D17) mean score was 17 (5.3) in H1-coil, 17 (5.4) in 8-coil, and 19 (6.1) in control group. The primary outcome was the proportion of patients achieving remission defined as HAM-D17 score ≤7 at end-of-treatment at week-4. In the intention-to-treat analysis odds ratio for remission was 1.74 (CI95% 0.79-3.83) in H1-coil compared to the 8-coil group. The difference between two rTMS protocols was not significant. Remission rate was significantly greater in both HF-rTMS groups compared to the control: 60% (CI95% 48-71%), 43% (CI95% 31-55%) and 11% (CI95% 5-20%) respectively. The response was significantly better in H1-coil, than in 8-coil group OR = 2.33; CI95% 1.04-5.21 (P = 0.040). The HAM-D17 was lowered by 59% in the H1-coil, 41% in the 8-coil (P = 0.048), and 17% in the control group (P < 0.001 vs H1-coil; P = 0.003 vs 8-coil). Safety, tolerability, and the changes in quality of life were comparable. We confirmed the safety and efficacy of both FDA-approved protocols as adjunctive treatments of MDD. Better response rate and greater reduction of depression severity were observed in the H1-coil group, but without a significant difference in the remission rate between the two rTMS modalities. CLINICAL TRIALS REGISTRATION: Clinicaltrials.govNCT02917499.
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Affiliation(s)
- Igor Filipčić
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | | | | | | | | | - Ena Ivezić
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia; Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Silvio Bašić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; Department of Neurology, Dubrava University Hospital, Zagreb, Croatia
| | - Žarko Bajić
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
| | - Markus Heilig
- Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Linköping University, Linköping, Sweden
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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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Stanley SA, Friedman JM. Electromagnetic Regulation of Cell Activity. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a034322. [PMID: 30249601 DOI: 10.1101/cshperspect.a034322] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The ability to observe the effects of rapidly and reversibly regulating cell activity in targeted cell populations has provided numerous physiologic insights. Over the last decade, a wide range of technologies have emerged for regulating cellular activity using optical, chemical, and, more recently, electromagnetic modalities. Electromagnetic fields can freely penetrate cells and tissue and their energy can be absorbed by metal particles. When released, the absorbed energy can in turn gate endogenous or engineered receptors and ion channels to regulate cell activity. In this manner, electromagnetic fields acting on external nanoparticles have been used to exert mechanical forces on cell membranes and organelles to generate heat and interact with thermally activated proteins or to induce receptor aggregation and intracellular signaling. More recently, technologies using genetically encoded nanoparticles composed of the iron storage protein, ferritin, have been used for targeted, temporal control of cell activity in vitro and in vivo. These tools provide a means for noninvasively modulating gene expression, intracellular organelles, such as endosomes, and whole-cell activity both in vitro and in freely moving animals. The use of magnetic fields interacting with external or genetically encoded nanoparticles thus provides a rapid noninvasive means for regulating cell activity.
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Affiliation(s)
- Sarah A Stanley
- Diabetes, Obesity and Metabolism Institute, Icahn School of Medicine at Mount Sinai, New York, New York 10029.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Jeffrey M Friedman
- Laboratory of Molecular Genetics, Rockefeller University, New York, New York 10065.,Howard Hughes Medical Institute, New York, New York 10065
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Dubin MJ, Ilieva IP, Deng ZD, Thomas J, Cochran A, Kravets K, Brody BD, Christos PJ, Kocsis JH, Liston C, Gunning FM. A double-blind pilot dosing study of low field magnetic stimulation (LFMS) for treatment-resistant depression (TRD). J Affect Disord 2019; 249:286-293. [PMID: 30784726 PMCID: PMC6486658 DOI: 10.1016/j.jad.2019.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Low field magnetic stimulation is a potentially rapid-acting treatment for depression with mood-enhancing effects in as little as one 20-min session. The most convincing data for LFMS has come from treating bipolar depression. We examined whether LFMS also has rapid mood-enhancing effects in treatment-resistant major depressive disorder, and whether these effects are dose-dependent. OBJECTIVE/HYPOTHESIS We hypothesized that a single 20-min session of LFMS would reduce depressive symptom severity and that the magnitude of this change would be greater after three 20-min sessions than after a single 20-min session. METHODS In a double-blind randomized controlled trial, 30 participants (age 21-65) with treatment-resistant depression were randomized to three 20-min active or sham LFMS treatments with 48 h between treatments. Response was assessed immediately following LFMS treatment using the 6-item Hamilton Depression Rating Scale (HAMD-6), the Positive and Negative Affect Scale (PANAS) and the Visual Analog Scale. RESULTS Following the 3rd session of LFMS, the effect of LFMS on VAS and HAMD-6 was superior to sham (F (1, 24) = 7.45, p = 0.03, Bonferroni-Holm corrected; F (1, 22) = 6.92, p = 0.03, Bonferroni-Holm corrected, respectively). There were no differences between sham and LFMS following the initial or second session with the effect not becoming significant until after the third session. CONCLUSIONS Three 20-min LFMS sessions were required for active LFMS to have a mood-enhancing effect for individuals with treatment-resistant depression. As this effect may be transient, future work should address dosing schedules of longer treatment courses as well as biomarker-based targeting of LFMS to optimize patient selection and treatment outcomes.
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Affiliation(s)
- Marc J Dubin
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA.
| | - Irena P Ilieva
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jeena Thomas
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ashly Cochran
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Kamilla Kravets
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Paul J Christos
- Department of Healthcare Policy and Research, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - James H Kocsis
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Sackler Institute for Developmental Psychobiology, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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Alternate day dTMS combined with SSRIs for chronic treatment resistant depression: A prospective multicenter study. J Affect Disord 2018; 240:130-136. [PMID: 30071416 DOI: 10.1016/j.jad.2018.07.058] [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] [Received: 11/29/2017] [Revised: 06/22/2018] [Accepted: 07/22/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Chronic treatment resistant depression takes a substantial toll on patients' quality of life and alternative treatment options are limited. This prospective multicenter study evaluated the safety, tolerability and efficacy of four weeks of thrice-a-week deep transcranial magnetic stimulation (dTMS) in combination with selective serotonin reuptake inhibitors (SSRIs). METHODS Forty patients who failed to respond during a 16-week double-blind placebo controlled (DBPC) trial of dTMS or sham dTMS as monotherapy were screened and started a treatment of previously tolerable but ineffective SSRI. After ten days of medication, high frequency dTMS was added three times a week for four weeks. RESULTS dTMS combined with SSRIs was well tolerated, with only headaches as a related adverse event (n = 4), which did not cause drop outs. Six patients were excluded from analysis: 1 was missing screening data and 5 received less than 10 sessions. Out of 34 patients included in this study, 12 (35.3%) patients remitted (HDRS-21 < 10). No significant differences were found between patients who had received sham or active dTMS in the earlier DBPC multicenter trial. LIMITATIONS This was a small scale open study of dTMS with SSRIs in patients that failed to respond during a DBPC dTMS trial, although a carryover effect cannot be excluded. Comparative efficacy of dTMS with and without SSRIs and specific dosing and protocol parameters warrant specifically-designed large-scale controlled studies. CONCLUSIONS Thrice weekly dTMS at 120% motor threshold(MT), 10 HZ, 3‑s trains, 20‑s intervals, 2400 daily pulses, can augment formerly ineffective SSRI treatment.
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McGirr A, Berlim MT. Clinical Usefulness of Therapeutic Neuromodulation for Major Depression: A Systematic Meta-Review of Recent Meta-Analyses. Psychiatr Clin North Am 2018; 41:485-503. [PMID: 30098660 DOI: 10.1016/j.psc.2018.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The authors conducted a meta-review of meta-analyses published in the past decade on therapeutic neuromodulation (ie, repetitive transcranial magnetic stimulation, transcranial direct current stimulation, vagus nerve stimulation and deep brain stimulation) for major depression. Active repetitive transcranial magnetic stimulation and transcranial direct current stimulation have been generally associated with small to moderate effect sizes vis-à-vis their efficacy and with similar acceptability compared with sham. Vagus nerve stimulation and deep brain stimulation (although more challenging to investigate) have demonstrated preliminary effectiveness, particularly during longer-term follow-up.
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Affiliation(s)
- Alexander McGirr
- Department of Psychiatry, Hotchkiss Brain Institute, Mathison Centre for Mental Health Research and Education, University of Calgary, TRW-4D68, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada.
| | - Marcelo T Berlim
- Neuromodulation Research Clinic, Depressive Disorders Program, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada.
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Mutz J, Edgcumbe DR, Brunoni AR, Fu CH. Efficacy and acceptability of non-invasive brain stimulation for the treatment of adult unipolar and bipolar depression: A systematic review and meta-analysis of randomised sham-controlled trials. Neurosci Biobehav Rev 2018; 92:291-303. [DOI: 10.1016/j.neubiorev.2018.05.015] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/30/2018] [Accepted: 05/09/2018] [Indexed: 12/15/2022]
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Kedzior KK, Gerkensmeier I, Schuchinsky M. Can deep transcranial magnetic stimulation (DTMS) be used to treat substance use disorders (SUD)? A systematic review. BMC Psychiatry 2018; 18:137. [PMID: 29776355 PMCID: PMC5960210 DOI: 10.1186/s12888-018-1704-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Deep transcranial magnetic stimulation (DTMS) is a non-invasive method of stimulating widespread cortical areas and, presumably, deeper neural networks. The current study assessed the effects of DTMS in the treatment of substance use disorders (SUD) using a systematic review. METHODS Electronic literature search (PsycInfo, Medline until April 2017) identified k = 9 studies (k = 4 randomized-controlled trials, RCTs, with inactive sham and k = 5 open-label studies). DTMS was most commonly applied using high frequency/intensity (10-20 Hz/100-120% of the resting motor threshold, MT) protocols for 10-20 daily sessions in cases with alcohol, nicotine or cocaine use disorders. The outcome measures were craving and dependence (according to standardized scales) or consumption (frequency, abstinence or results of biological assays) at the end of the daily treatment phases and at the last follow-up. RESULTS Acute and longer-term (6-12 months) reductions in alcohol craving were observed after 20 sessions (20 Hz, 120% MT) relative to baseline in k = 4 open-label studies with comorbid SUD and major depressive disorder (MDD). In k = 2 RCTs without MDD, alcohol consumption acutely decreased after 10-12 sessions (10-20 Hz, 100-120% MT) relative to baseline or to sham. Alcohol craving was reduced only after higher frequency/intensity DTMS (20 Hz, 120% MT) relative to sham in k = 1 RCT. Nicotine consumption was reduced and abstinence was increased after 13 sessions (10 Hz, 120% MT) and at the 6-month follow-up relative to sham in k = 1 RCT. Cocaine craving was reduced after 12 sessions (15 Hz, 100% MT) and at the 2-month follow-up relative to baseline in k = 1 open-label study while consumption was reduced after 12 sessions (10 Hz, 100% MT) relative to baseline but not to sham in k = 1 RCT. CONCLUSIONS High-frequency DTMS may be effective at treating some SUD both acutely and in the longer-term. Large RCTs with inactive sham are required to determine the efficacy and the optimal stimulation parameters of DTMS for the treatment of SUD.
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Affiliation(s)
| | - Imke Gerkensmeier
- 0000 0001 2297 4381grid.7704.4Institute of Psychology and Transfer, University of Bremen, Bremen, Germany
| | - Maria Schuchinsky
- 0000 0004 1936 9692grid.10049.3cUniversity of Limerick, Limerick, Ireland
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Rapinesi C, Kotzalidis GD, Ferracuti S, Girardi N, Zangen A, Sani G, Raccah RN, Girardi P, Pompili M, Del Casale A. Add-on high frequency deep transcranial magnetic stimulation (dTMS) to bilateral prefrontal cortex in depressive episodes of patients with major depressive disorder, bipolar disorder I, and major depressive with alcohol use disorders. Neurosci Lett 2018; 671:128-132. [PMID: 29454034 DOI: 10.1016/j.neulet.2018.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Dorsolateral prefrontal cortex (DLPFC) is critically involved in mood and alcohol use disorders. OBJECTIVE We aimed to investigate the safety of intervention with add-on bilateral prefrontal high-frequency deep transcranial magnetic stimulation (dTMS) and between-group differences in treatment response in patients with different types of depressive episodes, including major depressive episodes in the course of major depressive disorder (MDD), bipolar disorder, type I (BD-I), and MDD with alcohol use disorder (MDAUD). METHODS We conducted a 6-month open-label study, involving 82 patients with DSM-5 Depressive Episode. Of these, 41 had diagnosis of MDD, 20 BD-I, and 21 MDAUD. All patients received standard drug treatment and add-on dTMS over the bilateral DLPFC with left prevalence for four weeks, with five sessions in each week. We rated mood state with the Hamilton Depression Rating Scale (HDRS) at baseline, one-month, and six-month follow-up visits. RESULTS Mean total HDRS scores dropped from 22.8 (SD = 5.9) at baseline to 10.4 (SD = 3.6) at 1 month, to 10.0 (SD = 4.5) at 6 months, while response/remission were 70.73% (N = 58) and 19.51% (N = 16) at 1 month and 76.83% (N = 63) and 32.93% (27) at 6 months, respectively, with no between-group differences. No patient experienced any side effects. CONCLUSIONS High-frequency DLPFC dTMS was well tolerated and did not significantly differ on improvement of depression in MDD, BD-I, and MDAUD.
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Affiliation(s)
- Chiara Rapinesi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy.
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy
| | - Stefano Ferracuti
- Department of Neurology and Psychiatry, Sapienza University; Sant'Andrea Hospital, Rome, Italy
| | - Nicoletta Girardi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy; Unit of Psychiatry, "Umberto I" University Hospital, Rome, Italy
| | - Abraham Zangen
- Department of Life Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy; Lucio Bini Center, Aretæus Onlus, Rome, Italy
| | - Ruggero N Raccah
- ATID Ltd Advanced Technology Innovation Distribution, Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy; Lucio Bini Center, Aretæus Onlus, Rome, Italy
| | - Maurizio Pompili
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy
| | - Antonio Del Casale
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; Sant'Andrea Hospital, Rome, Italy
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Abstract
PURPOSE OF REVIEW This article aims to review select applications of Transcranial Magnetic Stimulation (TMS) that have significant relevance in geriatric psychiatry. RECENT FINDINGS Small study sizes and parameter variability limit the generalizability of many TMS studies in geriatric patients. Additionally, geriatric patients have unique characteristics that can moderate the efficacy of TMS. Nonetheless, several promising experimental applications in addition to the FDA-approved indication for major depression have emerged. Cognitive impairment, neuropathic pain, and smoking cessation are experimental applications with special significance to the elderly. Cognitive impairment has been researched the most in this population and evidence thus far suggests that TMS has potential therapeutic benefit. There is also evidence to suggest benefit from TMS for neuropathic pain and smoking cessation in working age adults. TMS is consistently reported as a safe and well-tolerated treatment modality with no adverse cognitive side effects. TMS is a safe treatment modality that can be effective for certain applications in the elderly. Additional research that specifically includes older subjects is needed to replicate findings and to optimize treatment protocols for this population.
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Affiliation(s)
- Ilva G Iriarte
- Department of Psychiatry, Medical University of South Carolina (MUSC), Charleston, SC, USA.
| | - Mark S George
- Department of Psychiatry, Medical University of South Carolina (MUSC), Charleston, SC, USA.,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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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: 332] [Impact Index Per Article: 55.3] [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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Gilligan J, Rasouli JJ, Kopell BH. Cortical Stimulation for Depression. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Del Casale A, Rapinesi C, Kotzalidis GD, Sorice S, Padovano A, Gentile G, Angeletti G, Ferracuti S, Sani G, Pompili M, Simmaco M, Girardi P. Stable Remission of Multiple Chemical Sensitivity Syndrome and Major Depression With Citalopram and 1-Month Deep Transcranial Magnetic Stimulation: A Case Report. J ECT 2017; 33:e27-e29. [PMID: 28570499 DOI: 10.1097/yct.0000000000000420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University and Unit of Psychiatry, Sant'Andrea Hospital, Rome and Department of Psychiatric Rehabilitation, P. Alberto Mileno Onlus Foundation, San Francesco Institute, Vasto, Chieti, Italy, Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University, Rome, Italy. Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University and Advanced Molecular Diagnostics Unit (DiMA), Sant'Andrea Hospital, Rome, Italy Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy Department of Neurology and Psychiatry, Sapienza University, Rome, Italy Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University and Advanced Molecular Diagnostics Unit (DiMA), Sant'Andrea Hospital, Rome, Italy Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), School of Medicine and Psychology, Sapienza University and Unit of Psychiatry, Sant'Andrea Hospital, Rome, Italy
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Avissar M, Powell F, Ilieva I, Respino M, Gunning FM, Liston C, Dubin MJ. Functional connectivity of the left DLPFC to striatum predicts treatment response of depression to TMS. Brain Stimul 2017; 10:919-925. [PMID: 28747260 DOI: 10.1016/j.brs.2017.07.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/03/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (TMS) is a non-invasive, safe, and efficacious treatment for depression. TMS has been shown to normalize abnormal functional connectivity of cortico-cortical circuits in depression and baseline functional connectivity of these circuits predicts treatment response. Less is known about the relationship between functional connectivity of frontostriatal circuits and treatment response. OBJECTIVE/HYPOTHESIS We investigated whether baseline functional connectivity of distinct frontostriatal circuits predicted response to TMS. METHODS Resting-state fMRI (rsfMRI) was acquired in 27 currently depressed subjects with treatment resistant depression and 27 healthy controls. Depressed subjects were treated with 5 weeks of daily TMS over the left dorsolateral prefrontal cortex (DLPFC). The functional connectivity between limbic, executive, rostral motor, and caudal motor regions of frontal cortex and their corresponding striatal targets were determined at baseline using an existing atlas based on diffusion tensor imaging. TMS treatment response was measured by percent reduction in the 24-item Hamilton Depression Rating Scale (HAMD24). In an exploratory analysis, correlations were determined between baseline functional connectivity and TMS treatment response. RESULTS Seven cortical clusters belonging to the executive and rostral motor frontostriatal projections had reduced functional connectivity in depression compared to healthy controls. No frontostriatal projections showed increased functional connectivity in depression (voxel-wise p < 0.01, family-wise α < 0.01). Only baseline functional connectivity between the left DLPFC and the striatum predicted TMS response. Higher baseline functional connectivity correlated with greater reductions in HAMD24 (Pearson's R = 0.58, p = 0.002). CONCLUSION(S) In an exploratory analysis, higher functional connectivity between the left DLPFC and striatum predicted better treatment response. Our findings suggest that the antidepressant mechanism of action of TMS may require connectivity from cortex proximal to the stimulation site to the striatum.
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Affiliation(s)
- Michael Avissar
- Division of Experimental Therapeutics, New York State Psychiatric Institute/Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Fon Powell
- Department of Radiology, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Irena Ilieva
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Matteo Respino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Institute of Geriatric Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Sackler Institute for Developmental Psychobiology, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Marc J Dubin
- Department of Psychiatry, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medical College-New York Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA.
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25
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Rakesh G, Pae CU, Masand PS. Beyond serotonin: newer antidepressants in the future. Expert Rev Neurother 2017; 17:777-790. [DOI: 10.1080/14737175.2017.1341310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Gopalkumar Rakesh
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Chi-Un Pae
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Prakash S. Masand
- Academic Medicine Education Institute, Duke-NUS Medical School, Singapore, Singapore
- Global Medical Education, New York, NY, USA
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Nordenskjöld A, Mårtensson B, Pettersson A, Heintz E, Landén M. Effects of Hesel-coil deep transcranial magnetic stimulation for depression - a systematic review. Nord J Psychiatry 2016; 70:492-7. [PMID: 27093104 PMCID: PMC5020337 DOI: 10.3109/08039488.2016.1166263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND One third of the depressed patients are not improved by antidepressant drugs and psychological treatments, and there is a need for additional treatments. Repetitive transcranial magnetic stimulation (rTMS) is being developed towards an alternative in treatment-resistant depression. Deep transcranial stimulation (dTMS) with the Hesel-coil (H-coil) is a further development of rTMS aiming to enhance the effect by getting the magnetic pulses to penetrate deeper into the brain. AIMS This report aims to assess the evidence-base for dTMS for depression. The report also includes an assessment of the ethical and economic aspects involved. METHODS A systematic review of the effects of H-coil dTMS on depression was conducted and the scientific support was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS Only one controlled study was identified. In the sham-controlled randomized study, 212 participants with major depression that had not responded to antidepressant medication were enrolled. A two-point superiority in Hamilton Depression Rating Scale was observed in the dTMS arm vs the sham-arm at 4 weeks, but the difference was not statistically significant. No serious adverse events were reported apart from rare cases of epileptic seizures. CONCLUSIONS The existing scientific support for H-coil dTMS therapy for depression is insufficient. The clinical implication is that the use of dTMS in depression should be restricted to the framework of clinical trials pending further studies. Fortunately, additional studies are underway and the evidence base should presumably improve over the next several years.
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Affiliation(s)
- Axel Nordenskjöld
- a Department of Psychiatry, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Björn Mårtensson
- b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Agneta Pettersson
- c Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) and Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden
| | - Emelie Heintz
- d Health Economist, Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) and Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden
| | - Mikael Landén
- e Institute of Neuroscience and Physiology, the Sahlgrenska Academy at Gothenburg University , Gothenburg, Sweden and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet , Stockholm , Sweden
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27
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Cognitive safety of dorsomedial prefrontal repetitive transcranial magnetic stimulation in major depression. Eur Neuropsychopharmacol 2016; 26:1213-26. [PMID: 27157074 DOI: 10.1016/j.euroneuro.2016.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/30/2016] [Accepted: 04/14/2016] [Indexed: 01/26/2023]
Abstract
The most widely used target for repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD) is the dorsolateral prefrontal cortex (DLPFC). Despite convergent evidence that the dorsomedial prefrontal cortex (DMPFC) may be a promising alternative target for rTMS in TRD, its cognitive safety profile has not previously been assessed. Here, we applied 20 sessions of rTMS to the DMPFC in 21 TRD patients. Before and after treatment, a battery of neuropsychological tasks was administered to evaluate changes in cognition across three general cognitive domains: learning and memory, attention and processing speed, and cognitive flexibility. Subjects also completed the 17-item Hamilton Rating Scale for Depression (HamD17) prior to and following treatment to measure changes in severity of depressive symptoms, and to assess the relationship between mood and cognitive performance over the course of treatment. No serious adverse effects or significant deterioration in cognitive performance were observed. Overall, subjects improved significantly on Stroop Inhibition/Switching and on Trails B, and this improvement was independent of the degree of improvement in depression symptoms. No domains or items significantly predicted clinical outcome, with the exception of baseline performance on Visual Elevator Accuracy. Clinical improvement correlated to improved performance in the overall domain of attention and processing speed, although this effect was not evident following covariate adjustment. DMPFC-rTMS did not produce any detectable cognitive adverse effects during treatment of TRD. Performance did not deteriorate significantly on any measures. Taken together, the present findings support the tolerability and cognitive safety of DMPFC-rTMS in refractory depression.
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Rapinesi C, Del Casale A, Scatena P, Kotzalidis GD, Di Pietro S, Ferri VR, Bersani FS, Brugnoli R, Raccah RN, Zangen A, Ferracuti S, Orzi F, Girardi P, Sette G. Add-on deep Transcranial Magnetic Stimulation (dTMS) for the treatment of chronic migraine: A preliminary study. Neurosci Lett 2016; 623:7-12. [DOI: 10.1016/j.neulet.2016.04.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 01/03/2023]
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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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Dunlop K, Hanlon CA, Downar J. Noninvasive brain stimulation treatments for addiction and major depression. Ann N Y Acad Sci 2016; 1394:31-54. [PMID: 26849183 PMCID: PMC5434820 DOI: 10.1111/nyas.12985] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Major depressive disorder (MDD) and substance use disorders (SUDs) are prevalent, disabling, and challenging illnesses for which new treatment options are needed, particularly in comorbid cases. Neuroimaging studies of the functional architecture of the brain suggest common neural substrates underlying MDD and SUDs. Intrinsic brain activity is organized into a set of functional networks, of which two are particularly relevant to psychiatry. The salience network (SN) is crucial for cognitive control and response inhibition, and deficits in SN function are implicated across a wide variety of psychiatric disorders, including MDD and SUDs. The ventromedial network (VMN) corresponds to the classic reward circuit, and pathological VMN activity for drug cues/negative stimuli is seen in SUDs/MDD. Noninvasive brain stimulation (NIBS) techniques, including rTMS and tDCS, have been used to enhance cortico–striatal–thalamic activity through the core SN nodes in the dorsal anterior cingulate cortex, dorsolateral prefrontal cortex, and anterior insula. Improvements in both MDD and SUD symptoms ensue, including in comorbid cases, via enhanced cognitive control. Inhibition of the VMN also appears promising in preclinical studies for quenching the pathological incentive salience underlying SUDs and MDD. Evolving techniques may further enhance the efficacy of NIBS for MDD and SUD cases that are unresponsive to conventional treatments.
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Affiliation(s)
- Katharine Dunlop
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Colleen A Hanlon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina.,Center for Biomedical Imaging, Medical University of South Carolina, Charleston, South Carolina
| | - Jonathan Downar
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada
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31
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Kedzior KK, Gellersen HM, Roth Y, Zangen A. Acute reduction in anxiety after deep transcranial magnetic stimulation (DTMS) in unipolar major depression- a systematic review and meta-analysis. Psychiatry Res 2015; 230:971-4. [PMID: 26616303 DOI: 10.1016/j.psychres.2015.11.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/21/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
The current study investigated the anxiolytic properties of the deep transcranial magnetic stimulation (DTMS) in unipolar major depression using a systematic literature review and meta-analysis. Compared to baseline, large anxiolytic and antidepressant outcomes were obtained after 20 daily sessions of high-frequency DTMS according to data from six open-label studies with 95 patients. Unlike the antidepressant effect, the anxiolytic effect was more heterogeneous among studies and did not depend on concurrent treatment with antidepressants.
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Affiliation(s)
| | | | - Yiftach Roth
- Department of Life Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Abraham Zangen
- Department of Life Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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