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Kabar M, Lopez-Chau L, Araujo-Banchon WJ. A real-world retrospective cohort study comparing two bilateral stimulation protocols of add-on rTMS in patients with treatment resistant depression and severe anxiety. Asian J Psychiatr 2024; 96:104013. [PMID: 38554561 DOI: 10.1016/j.ajp.2024.104013] [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: 11/03/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) has been shown to improve response and remission in patients with treatment resistant depression. The objective of this study was to compare the efficacy of two bilateral rTMS protocols with different protocols in patients with treatment resistant depression and comorbid severe anxiety. METHODS A retrospective cohort study involving 67 patients who underwent two different bilateral TMS protocols and who met the specified eligibility criteria was conducted. Group 1 received stimulation with 85% RMT intermittent theta burst (iTBS) in the left DLPFC + 120% RMT (1 Hz) in the right DLPFC. Group 2 received stimulation with 100% RMT (iTBS) in the left DLPFC + 110% RMT (1 Hz) in the left DLPFC. RESULTS After the magnetic stimulation treatment, 55% (n=22) achieved response to depression symptoms in group 1 and 62% (n=18) in group 2. Remission of depression symptoms was achieved in 13% in group 1 (n=5) and 24% in group 2 (n=7). There were no significant differences between the two protocols after TMS CONCLUSIONS: Different bilateral protocol parameters in individuals undergoing TMS may have an impact on symptom response and remission. Further studies with larger sample sizes are needed.
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Affiliation(s)
| | - Luis Lopez-Chau
- Instituto de Neuroestimulación de Lima. Lima, Peru; Escuela de Medicina, Universidad Científica del Sur. Lima, Peru.
| | - William J Araujo-Banchon
- Escuela de Medicina Humana, Universidad Cesar Vallejo. Piura, Peru; Estudios Cimedical. Lima, Peru
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Chou PH, Tu CH, Chen CM, Lu MK, Tsai CH, Hsieh WT, Lai HC, Satyanarayanan SK, Su KP. Bilateral theta-burst stimulation on emotional processing in major depressive disorder: A functional neuroimaging study from a randomized, double-blind, sham-controlled trial. Psychiatry Clin Neurosci 2022; 77:233-240. [PMID: 36579902 DOI: 10.1111/pcn.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022]
Abstract
AIM Bilateral theta-burst stimulation (biTBS; intermittent TBS over the left dorsolateral prefrontal cortex [DLPFC] and continuous TBS over the right DLPFC) has demonstrated efficacy in improving symptoms in patients with major depressive disorder (MDD). However, the underlying brain mechanisms remain unknown. The authors aimed to investigate the antidepressant efficacy of biTBS monotherapy and its effects on the brain responses measured by functional magnetic resonance imaging (fMRI) during emotional processing in MDD. METHODS The authors conducted a double-blind, randomized, sham-controlled trial of patients with MDD who exhibited no responses to at least one adequate antidepressant treatment for the prevailing episode. Recruited patients were randomly assigned to 10 biTBS monotherapy or sham stimulation sessions. The fMRI scans during performing emotional recognition task were obtained at baseline and after 10 sessions of treatment. Depressive symptoms were assessed using the 21-item Hamilton Rating Scale for Depression at baseline and the weeks 4, 8, 12, 16, 20, and 24 week. RESULTS The biTBS group (n = 17) exhibited significant decreases in depression scores compared with the sham group (n = 11) at week 8 (70% vs 40%; P = 0.02), and the significant differences persisted during the 24-week follow-up periods. At week 4, when the treatment course was completed, patients in the biTBS group, but not in the sham group, exhibited increased brain activities over the left superior and middle frontal gyrus during negative emotional stimuli. CONCLUSION The authors' findings provide the first evidence regarding the underlying neural mechanisms of biTBS therapy to improve clinical symptoms in patients with MDD.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Cheng-Hao Tu
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan.,Mind-Body Interface Laboratory, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ming Chen
- Mind-Body Interface Laboratory, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.,Department of Medical Imaging, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Kuei Lu
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chon-Haw Tsai
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Wan-Ting Hsieh
- Mind-Body Interface Laboratory, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Hui-Chen Lai
- Mind-Body Interface Laboratory, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | | | - Kuan-Pin Su
- Mind-Body Interface Laboratory, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
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Vaithianathan T, Blair M, Soares V, Rybak YE, Palaniyappan L, Richardson JD, Burhan AM. Bilateral sequential theta burst stimulation in depressed veterans with service related posttraumatic stress disorder: a feasibility study. BMC Psychiatry 2022; 22:81. [PMID: 35114979 PMCID: PMC8811967 DOI: 10.1186/s12888-022-03729-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression comorbid with posttraumatic stress disorder (PTSD) can be disabling and treatment resistant. Preliminary evidence suggests that repetitive transcranial magnetic stimulation (rTMS), may have a role in helping these patients. There are only few published studies using different rTMS paradigms including bilateral intermittent theta burst (iTBS) and low frequency rTMS. METHODS In this small cohort observation study, we examined the efficacy of bilateral sequential theta-burst stimulation (bsTBS) in 8 treatment resistant depression (TRD) military veterans with PTSD comorbidity stemming from military service experience. RESULTS bsTBS was generally well tolerated and resulted in 25% and 38% remission and response rates on Depression scores respectively; 25% remission and response rate on PTSD scores. DISCUSSION This study demonstrates preliminary feasibility and safety of bsTBS in TRD with comorbid military service related PTSD. We concluded that this paradigm might hold promise as a therapeutic tool to help patients with TRD co-morbid with military service related PTSD. Further adequately powered studies to compare rTMS treatment paradigms in this patient group are warranted.
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Affiliation(s)
- Thelepa Vaithianathan
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada
| | - Mervin Blair
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada
| | - Vanessa Soares
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada ,grid.55614.330000 0001 1302 4958MacDonald Franklin OSI Research Centre, London, Ontario Canada
| | - Yuri E. Rybak
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada
| | - Lena Palaniyappan
- grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada ,grid.39381.300000 0004 1936 8884Robarts Research Institute, University of Western Ontario, London, Ontario Canada
| | - J Don Richardson
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, Ontario Canada ,grid.55614.330000 0001 1302 4958MacDonald Franklin OSI Research Centre, London, Ontario Canada ,grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada
| | - Amer M. Burhan
- grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 9X4 Canada ,grid.39381.300000 0004 1936 8884Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario London, Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
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