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Tran L, Hahn L, Gill S, Ng F, Clarke P, Paterson T, Galletly C. Do benzodiazepines reduce the efficacy of transcranial magnetic stimulation? Australas Psychiatry 2024; 32:180-185. [PMID: 38299320 PMCID: PMC11103912 DOI: 10.1177/10398562241229623] [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] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To investigate the effect of concomitant use of benzodiazepines on the efficacy of repetitive transcranial magnetic stimulation (rTMS) in patients with treatment-resistant major depressive disorder (TR-MDD). METHODS This is a retrospective study comparing rTMS treatment outcomes between patients taking benzodiazepines (n = 59) and those who were not (n = 136). Participants completed the HAM-A, HAM-D17, MADRS and ZUNG at baseline and at the end of treatment. RESULTS Patients taking benzodiazepines during rTMS treatment did not show any difference in partial response, response or remission rates compared to patients not treated with benzodiazepines. There was a significant decrease (p < .0001) in depression and anxiety scores from baseline to post-treatment among both groups. CONCLUSIONS Concomitant benzodiazepine treatment had no effect on the efficacy of rTMS treatment of TRD, contrary to previous research.
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Affiliation(s)
- Lana Tran
- Psychiatry Trainee, School of Medicine, Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Lisa Hahn
- Research Officer, Ramsay Clinic Adelaide, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Shane Gill
- Consultant Psychiatrist, Ramsay Clinic Adelaide, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia; Director of Psychiatry Training, Adelaide, SA, Australia; and School of Medicine, Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Felicity Ng
- Consultant Psychiatrist, School of Medicine, Discipline of Psychiatry, University of Adelaide; and Ramsay Clinic Adelaide, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Patrick Clarke
- Consultant Psychiatrist, School of Medicine, Discipline of Psychiatry, University of Adelaide; and Ramsay Clinic Adelaide, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Tom Paterson
- Consultant Psychiatrist, School of Medicine, Discipline of Psychiatry, University of Adelaide; and Ramsay Clinic Adelaide, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Cherrie Galletly
- Emerita Professor, School of Medicine, Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia; and Consultant Psychiatrist, Northern Adelaide Local Health Network, Adelaide, SA, Australia
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Addicott MA, Kinney KR, Saldana S, Ip EHS, DeMaioNewton H, Bickel WK, Hanlon CA. A randomized controlled trial of intermittent theta burst stimulation to the medial prefrontal cortex for tobacco use disorder: Clinical efficacy and safety. Drug Alcohol Depend 2024; 258:111278. [PMID: 38579605 PMCID: PMC11088513 DOI: 10.1016/j.drugalcdep.2024.111278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE This study aimed to evaluate the clinical efficacy and safety of administering intermittent theta burst stimulation (iTBS) to the medial prefrontal cortex for tobacco use disorder. METHODS A randomized sham-controlled trial was conducted, with 38 participants receiving 28 sessions of active (n=25) or sham (n=13) iTBS (2 sessions/day, 600 pulses/session, 110% resting motor threshold, AFz target) along with smoking cessation education (Forever Free © booklets) over 14 visits. Primary outcomes included self-reported cigarette consumption and abstinence, verified by urinary cotinine tests. Secondary outcomes included symptoms of tobacco use disorder, negative mood, and safety/tolerability. RESULTS Both active and sham groups reported reduced cigarette consumption (β = -0.12, p = 0.015), cigarette craving (β = -0.16, p = 0.002), and tobacco withdrawal symptoms (β = -0.05, p < 0.001). However, there were no significant time x group interaction effects for any measure. Similarly, the two groups had no significant differences in urinary cotinine-verified abstinence. Adverse events occurred with similar frequency in both groups. CONCLUSION There were no differences in cigarette consumption between the active and sham iTBS groups, both groups decreased cigarette consumption similarly. Further research is needed to compare iTBS to standard high-frequency rTMS and explore the potential differences in efficacy. Despite limitations, this study contributes to experimental design considerations for TMS as a novel intervention for tobacco and other substance use disorders, emphasizing the need for a more comprehensive understanding of the stimulation parameters and target sites.
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Affiliation(s)
- Merideth A Addicott
- Department of Translational Neuroscience, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA.
| | - Kaitlin R Kinney
- Department of Translational Neuroscience, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Santiago Saldana
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Edward Hak-Sing Ip
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Hannah DeMaioNewton
- Department of Translational Neuroscience, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA
| | - Colleen A Hanlon
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA; BrainsWay, Burlington, MA 01803, USA
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Sahlem GL, Kim B, Baker NL, Wong BL, Caruso MA, Campbell LA, Kaloani I, Sherman BJ, Ford TJ, Musleh AH, Kim JP, Williams NR, Manett AJ, Kratter IH, Short EB, Killeen TK, George MS, McRae-Clark AL. A preliminary randomized controlled trial of repetitive transcranial magnetic stimulation applied to the left dorsolateral prefrontal cortex in treatment seeking participants with cannabis use disorder. Drug Alcohol Depend 2024; 254:111035. [PMID: 38043228 PMCID: PMC10837319 DOI: 10.1016/j.drugalcdep.2023.111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have therapeutic clinical effects when applied in serial-sessions. The present study sought to preliminarily determine whether serial-sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. METHODS This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, two-sessions-per-visit, two-visits-per-week, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post- treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. RESULTS There were no significant differences in craving between conditions. Participants who received active-rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham-rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active-rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period than those receiving sham-rTMS (Active vs. Sham: -0.72; Z=-2.33, p=0.02). CONCLUSIONS This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
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Affiliation(s)
- Gregory L Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nathaniel L Baker
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Brendan L Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Margaret A Caruso
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Lauren A Campbell
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Irakli Kaloani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Brian J Sherman
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Tiffany J Ford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Ahmad H Musleh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Jane P Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrew J Manett
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Ian H Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Edward B Short
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Terese K Killeen
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S George
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Aimee L McRae-Clark
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
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Sahlem GL, Kim B, Baker NL, Wong BL, Caruso MA, Campbell LA, Kaloani I, Sherman BJ, Ford TJ, Musleh AH, Kim JP, Williams NR, Manett AJ, Kratter IH, Short EB, Killeen TK, George MS, McRae-Clark AL. A Preliminary Investigation Of Repetitive Transcranial Magnetic Stimulation Applied To The Left Dorsolateral Prefrontal Cortex In Treatment Seeking Participants With Cannabis Use Disorder. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.10.23292461. [PMID: 37503294 PMCID: PMC10370231 DOI: 10.1101/2023.07.10.23292461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background Cannabis use disorder (CUD) is a common and consequential disorder. When applied to the dorsolateral prefrontal cortex (DLPFC), repetitive transcranial magnetic stimulation (rTMS) reduces craving across substance use disorders and may have a therapeutic clinical effect when applied in serial sessions. The present study sought to preliminarily determine whether serial sessions of rTMS applied to the DLPFC had a therapeutic effect in CUD. Methods This study was a two-site, phase-2, double-blind, randomized-controlled-trial. Seventy-two treatment-seeking participants (37.5% Women, mean age 30.2±9.9SD) with ≥moderate-CUD were randomized to active or sham rTMS (Beam-F3, 10Hz, 20-total-sessions, with cannabis cues) while undergoing a three-session motivational enhancement therapy intervention. The primary outcome was the change in craving between pre- and post-treatment (Marijuana Craving Questionnaire Short-Form-MCQ-SF). Secondary outcomes included the number of weeks of abstinence and the number of days-per-week of cannabis use during 4-weeks of follow-up. Results There were no significant differences in craving between conditions. Participants who received active rTMS reported numerically, but not significantly, more weeks of abstinence in the follow-up period than those who received sham rTMS (15.5%-Active; 9.3%-Sham; rate ratio = 1.66 [95% CI: 0.84, 3.28]; p=0.14). Participants who received active rTMS reported fewer days-per-week of cannabis use over the final two-weeks of the follow-up period (Active vs. Sham: -0.72; Z=-2.33, p=0.02). Conclusions This trial suggests rTMS is safe and feasible in individuals with CUD and may have a therapeutic effect on frequency of cannabis use, though further study is needed with additional rTMS-sessions and a longer follow-up period.
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Affiliation(s)
- Gregory L. Sahlem
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Bohye Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Nathaniel L. Baker
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brendan L. Wong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Margaret A. Caruso
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren A. Campbell
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Irakli Kaloani
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Brian J. Sherman
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Tiffany J. Ford
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Ahmad H. Musleh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Jane P. Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Nolan R. Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Andrew J. Manett
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ian H. Kratter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Edward B. Short
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Terese K. Killeen
- Departments of Psychiatry, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark S. George
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
| | - Aimee L. McRae-Clark
- Departments of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina, USA
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5
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Seybert C, Cotovio G, Grácio J, Oliveira-Maia AJ. Future Perspectives From a Case Report of Transcranial Magnetic Stimulation, Cognitive Behavioral Therapy, and Psychopharmacological Treatment for Post-traumatic Stress Disorder. Front Psychol 2021; 12:728130. [PMID: 34589030 PMCID: PMC8473870 DOI: 10.3389/fpsyg.2021.728130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Carolina Seybert
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jaime Grácio
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
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Adu MK, Eboreime E, Sapara AO, Greenshaw AJ, Chue P, Agyapong VIO. The use of repetitive transcranial magnetic stimulation for treatment of obsessive-compulsive disorder: a scoping review. Ment Illn 2021; 13:1-13. [PMID: 35432816 PMCID: PMC8936147 DOI: 10.1108/mij-05-2021-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This paper aims to explore the relevant literature available regarding the use of repetitive transcranial magnetic stimulation (rTMS) as a mode of treatment for obsessive-compulsive disorder (OCD); to evaluate the evidence to support the use of rTMS as a treatment option for OCD. Design/methodology/approach The authors electronically conducted data search in five research databases (MEDLINE, CINAHL, Psych INFO, SCOPUS and EMBASE) using all identified keywords and index terms across all the databases to identify empirical studies and randomized controlled trials. The authors included articles published with randomized control designs, which aimed at the treatment of OCD with rTMS. Only full-text published articles written in English were reviewed. Review articles on treatment for conditions other than OCD were excluded. The Covidence software was used to manage and streamline the review. Findings Despite the inconsistencies in the published literature, the application of rTMS over the supplementary motor area and the orbitofrontal cortex has proven to be promising in efficacy and tolerability compared with other target regions such as the prefrontal cortex for the treatment of OCD. Despite the diversity in terms of the outcomes and clinical variability of the studies under review, rTMS appears to be a promising treatment intervention for OCD. Research limitations/implications The authors of this scoping review acknowledge several limitations. First, the search strategy considered only studies published in English and the results are up to date as the last day of the electronic data search of December 10, 2020. Though every effort was made to identify all relevant studies for the purposes of this review per the eligibility criteria, the authors still may have missed some relevant studies, especially those published in other languages. Originality/value This review brought to bare the varying literature on the application of rTMS and what is considered gaps in the knowledge in this area in an attempt to evaluate and provide information on the potential therapeutic effects of rTMS for OCD.
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Affiliation(s)
- Medard Kofi Adu
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta Edmonton Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta Edmonton Canada
| | | | - Andrew James Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta Edmonton Canada
| | - Pierre Chue
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta Edmonton Canada
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Goldsworthy MR, Hordacre B, Rothwell JC, Ridding MC. Effects of rTMS on the brain: is there value in variability? Cortex 2021; 139:43-59. [PMID: 33827037 DOI: 10.1016/j.cortex.2021.02.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/16/2021] [Accepted: 02/26/2021] [Indexed: 01/02/2023]
Abstract
The ability of repetitive transcranial magnetic stimulation (rTMS) to non-invasively induce neuroplasticity in the human cortex has opened exciting possibilities for its application in both basic and clinical research. Changes in the amplitude of motor evoked potentials (MEPs) elicited by single-pulse transcranial magnetic stimulation has so far provided a convenient model for exploring the neurophysiology of rTMS effects on the brain, influencing the ways in which these stimulation protocols have been applied therapeutically. However, a growing number of studies have reported large inter-individual variability in the mean MEP response to rTMS, raising legitimate questions about the usefulness of this model for guiding therapy. Although the increasing application of different neuroimaging approaches has made it possible to probe rTMS-induced neuroplasticity outside the motor cortex to measure changes in neural activity that impact other aspects of human behaviour, the high variability of rTMS effects on these measurements remains an important issue for the field to address. In this review, we seek to move away from the conventional facilitation/inhibition dichotomy that permeates much of the rTMS literature, presenting a non-standard approach for measuring rTMS-induced neuroplasticity. We consider the evidence that rTMS is able to modulate an individual's moment-to-moment variability of neural activity, and whether this could have implications for guiding the therapeutic application of rTMS.
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Affiliation(s)
- Mitchell R Goldsworthy
- Lifespan Human Neurophysiology Group, Adelaide Medical School, University of Adelaide, Adelaide, Australia; Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, Australia.
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Michael C Ridding
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia
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Ford H, Hahn L, Clarke P, Gill S, Carnell B, Galletly C. A comparison of 15 minute vs 30 minute repetitive transcranial magnetic stimulation sessions for treatment resistant depression - are longer treatment sessions more effective? J Affect Disord 2021; 282:974-978. [PMID: 33601742 DOI: 10.1016/j.jad.2021.01.009] [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: 10/28/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) is a safe and effective treatment for treatment resistant depression (TRD). The number of patients able to be treated with rTMS is determined by the availability of the machine and staff. If treatment delivered in a shorter time were just as effective as longer treatments, then more patients could be treated with the same resources. METHOD This naturalistic study investigated 145 first-time patients treated with 15 minute (900 pulses) or 30 minute (1800 pulses) RLF rTMS for TRD 3 days/week for 6 weeks. Response and remission rates for the two groups were compared. We investigated whether longer right unilateral low (1Hz) frequency (RLF) repetitive transcranial magnetic stimulation (rTMS) treatment sessions are more effective than shorter sessions in achieving response and remission for treatment resistant depression (TRD). RESULTS The duration of rTMS treatment sessions had no effect on treatment outcomes over the course of 6 weeks. The group treated with 15 minute rTMS sessions showed a partial response rate of 28.2%, a response rate of 11.5% and remission rate of 21.8%, which did not differ significantly from patients receiving 30 minute sessions who had a partial response rate of 25.4%, response rate of 17.9% and remission rate of 22.4%. LIMITATIONS Participants were not randomized and the inclusion criteria were broad and reflected the nature of patients seen in routine practice. CONCLUSIONS Fifteen minute rTMS sessions 3 days/week for 6 weeks were as effective as 30 minute sessions, providing a pragmatic advantage for shorter treatments.
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Affiliation(s)
- Hannah Ford
- School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Lisa Hahn
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Patrick Clarke
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Shane Gill
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Ben Carnell
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Cherrie Galletly
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services; Discipline of Psychiatry, University of Adelaide; Northern Adelaide Local Health Network, Adelaide, SA, Australia.
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9
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Kullakçi H, Sonkaya AR. The Investigation of the Effects of Repetitive Transcranialmagnetic Stimulation Treatment on Taste and Smell Sensations in Depressed Patients. ACTA ACUST UNITED AC 2021; 58:26-33. [PMID: 33795949 DOI: 10.29399/npa.25087] [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: 03/03/2020] [Accepted: 08/18/2020] [Indexed: 11/07/2022]
Abstract
Introduction Loss in sense of smell and taste is a condition that can occur without an organic pathology and it is noteworthy in patients diagnosed with Major Depressive Disorder (MDD). Few studies have shown that Repetitive Transcranial Magnetic Stimulation (tTMS) can correct losses in sense of smell and taste. In this study, we aimed to examine the effects of tTMS treatment applied to patients diagnosed with MDD on the sense of smell and taste in this patient group. Methods The sense of smell of 56 patients who were diagnosed with MDD and had tTMS indication was examined with the "Sniffin' Sticks" smell test and the sense of taste with the "Taste Strips" taste test. MDD patients who lost at least one sense of smell and taste were included in the study, but a total of 30 patients were able to complete the study. Hamilton Depression Scale (HAM-D) was applied to the patients before tTMS treatment, and this scale was repeated after 15 sessions of tTMS treatment. Taste and smell senses were re-evaluated after the last tTMS session. Results According to the Sniffin Stick Smell test, 15 of 29 patients with hyposmia had normosmia after tTMS, and 16 of 18 patients who were found to have hypogeusia according to Taste Strips Taste test had Normogeusia after tTMS. There was a positive improvement in both the smell and taste scores of all patients who were treated, compared to before tTMS. The positive improvement in the smell tests of the patients who responded to the treatment according to the HAM-D scores was found to be significantly different than the patients who did not respond. Conclusion The positive effect of tTMS treatment on the sense of smell and taste has been demonstrated even in patients whose HAM-D scores could not be sufficiently decreased. In patients diagnosed with depression, using tTMS alone or adding it to the current treatment suggests that it may have a positive effect on the sense of smell and taste as well as depression treatment.
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Affiliation(s)
- Hakan Kullakçi
- Health Science University, Sultan Abdülhamid Han Training and Research Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Ali Rıza Sonkaya
- Health Science University, Gülhane School of Medicine, Department of Neurology, Ankara, Turkey
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10
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Hett D, Marwaha S. Repetitive Transcranial Magnetic Stimulation in the Treatment of Bipolar Disorder. Ther Adv Psychopharmacol 2020; 10:2045125320973790. [PMID: 33282175 PMCID: PMC7682206 DOI: 10.1177/2045125320973790] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
Bipolar disorder (BD) is a debilitating mood disorder marked by manic, hypomanic and/or mixed or depressive episodes. It affects approximately 1-2% of the population and is linked to high rates of suicide, functional impairment and poorer quality of life. Presently, treatment options for BD are limited. There is a strong evidence base for pharmacological (e.g., lithium) and psychological (e.g., psychoeducation) treatments; however, both of these pose challenges for treatment outcomes (e.g., non-response, side-effects, limited access). Repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation technique, is a recommended treatment for unipolar depression, but it is unclear whether rTMS is an effective, safe and well tolerated treatment in people with BD. This article reviews the extant literature on the use of rTMS to treat BD across different mood states. We found 34 studies in total (N = 611 patients), with most assessing bipolar depression (n = 26), versus bipolar mania (n = 5), mixed state bipolar (n = 2) or those not in a current affective episode (n = 1). Across all studies, there appears to be a detectable signal of efficacy for rTMS treatment, as most studies report that rTMS treatment reduced bipolar symptoms. Importantly, within the randomised controlled trial (RCT) study designs, most reported that rTMS was not superior to sham in the treatment of bipolar depression. However, these RCTs are based on small samples (NBD ⩽ 52). Reported side effects of rTMS in BD include headache, dizziness and sleep problems. Ten studies (N = 14 patients) reported cases of affective switching; however, no clear pattern of potential risk factors for affective switching emerged. Future adequately powered, sham-controlled trials are needed to establish the ideal rTMS treatment parameters to help better determine the efficacy of rTMS for the treatment of BD.
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Affiliation(s)
- Danielle Hett
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- National Centre for Mental Health, Birmingham, UK
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, UK
- National Centre for Mental Health, Birmingham, UK
- Specialist Mood Disorders Clinic, Zinnia Centre, Birmingham and Solihull Mental Health Trust, Birmingham, UK
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11
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Fitzgerald PB. An update on the clinical use of repetitive transcranial magnetic stimulation in the treatment of depression. J Affect Disord 2020; 276:90-103. [PMID: 32697721 DOI: 10.1016/j.jad.2020.06.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an increasingly used treatment for patients with depression. The use of rTMS in depression is supported by over 20 years of clinical trials. There has been a significant increase in knowledge around the use of rTMS in recent years. OBJECTIVE The aim of this paper was to review the use of rTMS in depression to provide an update for rTMS practitioners and clinicians interested in the clinical use of this treatment. METHODS A targeted review of the literature around the use of rTMS treatment of depression with a specific focus on studies published in the last 3 years. RESULTS High-frequency rTMS applied to the left dorsolateral prefrontal cortex is an effective treatment for acute episodes of major depressive disorder. There are several additional methods of rTMS delivery that are supported by clinical trials and meta-analyses but no substantive evidence that any one approach is any more effective than any other. rTMS is effective in unipolar depression and most likely bipolar depression. rTMS courses may be repeated in the management of depressive relapse but there is less evidence for the use of rTMS in the maintenance phase. CONCLUSIONS The science around the use of rTMS is rapidly evolving and there is a considerable need for practitioners to remain abreast of the current state of this literature and its implications for clinical practice. rTMS is an effective antidepressant treatment but its optimal use should be continually informed by knowledge of the state of the art.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Central Clinical School, 888 Toorak Rd, Camberwell, Victoria 3004, Australia.
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12
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Abou El-Magd RM, Obuobi-Donkor G, Adu MK, Lachowski C, Duddumpudi S, Lawal MA, Sapara AO, Achor M, Kouzehgaran M, Hegde R, Chew C, Mach M, Daubert S, Urichuk L, Snaterse M, Surood S, Li D, Greenshaw A, Agyapong VIO. Repetitive Transcranial Magnetic Stimulation With and Without Internet-Delivered Cognitive-Behavioral Therapy for the Treatment of Resistant Depression: Protocol for Patient-Centered Randomized Controlled Pilot Trial. JMIR Res Protoc 2020; 9:e18843. [PMID: 33107835 PMCID: PMC7655463 DOI: 10.2196/18843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/25/2020] [Accepted: 08/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Major depression is a severe, disabling, and potentially lethal clinical disorder. Only about half of patients respond to an initial course of antidepressant pharmacotherapy. At least 15% of all patients with major depressive disorder (MDD) remain refractory to any treatment intervention. By the time that a patient has experienced 3 definitive treatment failures, the likelihood of achieving remission with the fourth treatment option offered is below 10%. Repetitive transcranial magnetic stimulation (rTMS) is considered a treatment option for patients with MDD who are refractory to antidepressant treatment. It is not currently known if the addition of internet-delivered cognitive-behavioral therapy (iCBT) enhances patients' responses to rTMS treatments. OBJECTIVE This study will evaluate the initial comparative clinical effectiveness of rTMS with and without iCBT as an innovative patient-centered intervention for the treatment of participants diagnosed with treatment-resistant depression (TRD). METHODS This study is a prospective, two-arm randomized controlled trial. In total, 100 participants diagnosed with resistant depression at a psychiatric care clinic in Edmonton, Alberta, Canada, will be randomized to one of two conditions: (1) enrolment in rTMS sessions alone and (2) enrolment in the rTMS sessions plus iCBT. Participants in each group will complete evaluation measures (eg, recovery, general symptomatology, and functional outcomes) at baseline, 1 month, 3 months, and 6 months. The primary outcome measure will be the mean change to scores on the Hamilton Depression Rating Scale. Patient service utilization data and clinician-rated measures will also be used to gauge patient progress. Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses. RESULTS We expect the results of the study to be available in 24 months. We hypothesize that participants enrolled in the study who receive rTMS plus iCBT will achieve superior outcomes in comparison to participants who receive rTMS alone. CONCLUSIONS The concomitant application of psychotherapy with rTMS has not been investigated previously. We hope that this project will provide us with a concrete base of data to evaluate the practical application and efficacy of using a novel combination of these two treatment modalities (rTMS plus iCBT). TRIAL REGISTRATION ClinicalTrials.gov NCT0423965; https://clinicaltrials.gov/ct2/show/NCT04239651. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/18843.
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Affiliation(s)
- Rabab M Abou El-Magd
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Medard K Adu
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christopher Lachowski
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Surekha Duddumpudi
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mobolaji A Lawal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adegboyega O Sapara
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael Achor
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Maryam Kouzehgaran
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Roshan Hegde
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Corina Chew
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Mike Mach
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shelley Daubert
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Liana Urichuk
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Mark Snaterse
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Daniel Li
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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13
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Luan D, Zhao MG, Shi YC, Li L, Cao YJ, Feng HX, Zhang ZJ. Mechanisms of repetitive transcranial magnetic stimulation for anti-depression: Evidence from preclinical studies. World J Psychiatry 2020; 10:223-233. [PMID: 33134113 PMCID: PMC7582130 DOI: 10.5498/wjp.v10.i10.223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 02/05/2023] Open
Abstract
This review summarizes the anti-depressant mechanisms of repetitive transcranial magnetic stimulation in preclinical studies, including anti-inflammatory effects mediated by activation of nuclear factor-E2-related factor 2 signaling pathway, anti-oxidative stress effects, enhancement of synaptic plasticity and neurogenesis via activation of the endocannabinoid system and brain derived neurotrophic factor signaling pathway, increasing the content of monoamine neurotransmitters via inhibition of Sirtuin 1/monoamine oxidase A signaling pathway, and reducing the activity of the hypothalamic-pituitary-adrenocortical axis. We also discuss the shortcomings of transcranial magnetic stimulation in preclinical studies such as inaccurate positioning, shallow depth of stimulation, and difficulty in elucidating the neural circuit mechanism up- and down-stream of the stimulation target brain region.
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Affiliation(s)
- Di Luan
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ming-Ge Zhao
- Department of Nursing, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ya-Chen Shi
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ling Li
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yu-Jia Cao
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Hai-Xia Feng
- Department of Nursing, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Zhi-Jun Zhang
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Psychology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang province, China
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14
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Kokdere F, Tirrell E, Fukuda AM, Gobin AP, Kavanaugh BC, Price LH, Carpenter LL. Do deviations from the 5 sessions per week schedule impact outcomes of transcranial magnetic stimulation for major depressive disorder? Brain Stimul 2020; 13:1491-1493. [PMID: 32768691 DOI: 10.1016/j.brs.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Fatih Kokdere
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Eric Tirrell
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA
| | - Andrew M Fukuda
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Asi Polly Gobin
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA
| | - Brian C Kavanaugh
- Emma Pendleton Bradley Hospital, Riverside, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lawrence H Price
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Linda L Carpenter
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
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15
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Xue SS, Xue F, Ma QR, Wang SQ, Wang Y, Tan QR, Wang HN, Zhou CH, Peng ZW. Repetitive high-frequency transcranial magnetic stimulation reverses depressive-like behaviors and protein expression at hippocampal synapses in chronic unpredictable stress-treated rats by enhancing endocannabinoid signaling. Pharmacol Biochem Behav 2019; 184:172738. [PMID: 31229467 DOI: 10.1016/j.pbb.2019.172738] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 12/15/2022]
Abstract
The anti-depressant effect of repetitive transcranial magnetic stimulation (rTMS), a clinically-useful treatment for depression, is associated with changes to the endocannabinoid system (ECS). However, it is currently unknown whether different frequencies of rTMS alter the ECS differently. To test this, rats exposed to chronic unpredictable stress (CUS) were treated with rTMS at two different frequencies (5 (high) or 1 Hz (low), 1.26 Tesla) for 7 consecutive days. Twenty-four hours after the final rTMS treatment, we evaluated depressive-like behaviors and the expression of several synaptic proteins and ECS-related proteins in the hippocampus. In addition, we knocked-down diacylglycerol lipase alpha (DAGLα) and cannabinoid type 1 receptor (CB1R), two important components of the ECS, and measured depressive-like behaviors and synaptic protein expression following rTMS. Furthermore, we measured the expression levels of several components of the ECS system in hippocampal-derived astrocytes and neurons exposed to repetitive magnetic stimulation (rMS) with different parameters (5 or 1 Hz, 0.84 or 1.26 Tesla). Interestingly, we found that only high-frequency rTMS ameliorated depressive-like behaviors and normalized the expression of hippocampal synaptic proteins in CUS-treated rats; this effect was eliminated by knockdown of DAGLα or CB1R. Moreover, we found that rMS at 5 Hz increased the expression of DAGLα and CB1R in hippocampal astrocytes and neurons. Collectively, our results suggest that high-frequency rTMS exerts its anti-depressant effect by up-regulating DAGLα and CB1R.
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Affiliation(s)
- Shan-Shan Xue
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Fen Xue
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Quan-Rui Ma
- Department of Human Anatomy and Histology and Embryology, Basic Medical College, Ningxia Medical University, 750004, China
| | - Shi-Quan Wang
- Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Ying Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Qing-Rong Tan
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Hua-Ning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Cui-Hong Zhou
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
| | - Zheng-Wu Peng
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
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16
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Clarke E, Clarke P, Gill S, Paterson T, Hahn L, Galletly C. Efficacy of repetitive transcranial magnetic stimulation in the treatment of depression with comorbid anxiety disorders. J Affect Disord 2019; 252:435-439. [PMID: 31003113 DOI: 10.1016/j.jad.2019.03.085] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The presence of comorbid anxiety is generally associated with poorer treatment outcomes in people with depression. Repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective for treatment resistant depression, but there has been little research examining rTMS in depressed patients with comorbid anxiety disorders. This study aimed to investigate the efficacy of rTMS in patients with treatment resistant Major Depressive Disorder (MDD) and comorbid anxiety disorders. METHODS This study included 248 patients with treatment resistant MDD who were treated with rTMS. Of these, 172 patients had one or more comorbid anxiety disorders, so their outcomes were compared with patients who did not have comorbid anxiety. RESULTS Patients both with and without comorbid anxiety disorders showed improvement in depression ratings after rTMS treatment, with no significant difference in remission rates between groups. In those with comorbid anxiety disorders, 23.3% met criteria for remission and 39.5% met response criteria. For each anxiety disorder diagnosis, there was a significant reduction in HAM-A, HAM-D21, MADRS and ZUNG scores (p = <0.001 for all). LIMITATIONS This was not a sham-controlled study, so placebo response rates are not known. Patients were referred by private psychiatrists so are not representative of all patients with depression. CONCLUSION Our study indicates that rTMS is an effective treatment for Major Depressive Disorder in people who have comorbid anxiety disorders.
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Affiliation(s)
| | - Patrick Clarke
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, South Australia, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, South Australia, Australia
| | - Shane Gill
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, South Australia, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, South Australia, Australia
| | - Tom Paterson
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, South Australia, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, South Australia, Australia
| | - Lisa Hahn
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, South Australia, Australia
| | - Cherrie Galletly
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, South Australia, Australia; Discipline of Psychiatry, School of Medicine, The University of Adelaide, South Australia, Australia; Northern Adelaide Local Health Network, South Australia, Australia.
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17
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Shalbaf R, Brenner C, Pang C, Blumberger DM, Downar J, Daskalakis ZJ, Tham J, Lam RW, Farzan F, Vila-Rodriguez F. Non-linear Entropy Analysis in EEG to Predict Treatment Response to Repetitive Transcranial Magnetic Stimulation in Depression. Front Pharmacol 2018; 9:1188. [PMID: 30425640 PMCID: PMC6218964 DOI: 10.3389/fphar.2018.01188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Biomarkers that predict clinical outcomes in depression are essential for increasing the precision of treatments and clinical outcomes. The electroencephalogram (EEG) is a non-invasive neurophysiological test that has promise as a biomarker sensitive to treatment effects. The aim of our study was to investigate a novel non-linear index of resting state EEG activity as a predictor of clinical outcome, and compare its predictive capacity to traditional frequency-based indices. Methods: EEG was recorded from 62 patients with treatment resistant depression (TRD) and 25 healthy comparison (HC) subjects. TRD patients were treated with excitatory repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) for 4 to 6 weeks. EEG signals were first decomposed using the empirical mode decomposition (EMD) method into band-limited intrinsic mode functions (IMFs). Subsequently, Permutation Entropy (PE) was computed from the obtained second IMF to yield an index named PEIMF2. Receiver Operator Characteristic (ROC) curve analysis and ANOVA test were used to evaluate the efficiency of this index (PEIMF2) and were compared to frequency-band based methods. Results: Responders (RP) to rTMS exhibited an increase in the PEIMF2 index compared to non-responders (NR) at F3, FCz and FC3 sites (p < 0.01). The area under the curve (AUC) for ROC analysis was 0.8 for PEIMF2 index for the FC3 electrode. The PEIMF2 index was superior to ordinary frequency band measures. Conclusion: Our data show that the PEIMF2 index, yields superior outcome prediction performance compared to traditional frequency band indices. Our findings warrant further investigation of EEG-based biomarkers in depression; specifically entropy indices applied in band-limited EEG components. Registration in ClinicalTrials.Gov; identifiers NCT02800226 and NCT01887782.
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Affiliation(s)
- Reza Shalbaf
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Colleen Brenner
- Department of Psychology, Loma Linda University, Loma Linda, CA, United States
| | - Christopher Pang
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,MRI-Guided rTMS Clinic and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Joseph Tham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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18
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Repetitive transcranial magnetic stimulation inhibits Sirt1/MAO-A signaling in the prefrontal cortex in a rat model of depression and cortex-derived astrocytes. Mol Cell Biochem 2017; 442:59-72. [PMID: 28948423 DOI: 10.1007/s11010-017-3193-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/09/2017] [Indexed: 02/06/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a useful monotherapy for depression or adjunctive therapy for resistant depression. However, the anti-depressive effects of different parameters and the underlying mechanisms remain unclear. Here, we aimed to assess the effect of rTMS with different parameters (1/5/10 Hz, 0.84/1.26 T) on the depressive-like behaviors, 5-hydroxytryptamine (5-HT), 5-HIAA (5-hydroxyindoleacetic acid) and DA and NE levels, and monoamine oxidase A (MAO-A) activity in chronic unpredictable stress-treated rats, along with the expression of sirtuin 1 (Sirt1) and MAO-A in the prefrontal cortex (PFC) and cortex-derived astrocytes from new-born rats. Moreover, the depressive-like behaviors were monitored following the transcranial injection of the Sirt1 inhibitor EX527 (1 mM) daily for 1 week. We found that rTMS treatment (5/10 Hz, 0.84/1.26 T) ameliorated depressive-like behaviors, increased 5-HT, DA and NE levels, decreased the 5-HIAA level and Sirt1 and MAO-A expression, and reduced MAO-A activity in the PFC. The depressive-like behaviors were also ameliorated after the transcranial injection of EX527. Importantly, rTMS (5/10 Hz, 0.84/1.26 T) inhibited Sirt1 and MAO-A expressions in astrocytes and Sirt1 knockdown with short hairpin RNA decreased MAO-A expression in astrocytes. These results suggest that the inhibition of Sirt1/MAO-A expression in astrocytes in the PFC may contribute to the different anti-depressive effects of rTMS with different parameters, and may also provide a novel insight into the mechanisms underlying major depressive disorder.
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Two Versus One High-Frequency Repetitive Transcranial Magnetic Stimulation Session per Day for Treatment-Resistant Depression: A Randomized Sham-Controlled Trial. J ECT 2017; 33:190-197. [PMID: 28072660 DOI: 10.1097/yct.0000000000000387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has proven antidepressant effects, but the optimal frequency of sessions remains unclear. METHODS We conducted a 3-week, sham-controlled trial to assess the antidepressant efficacy of 1 active HF-rTMS session per day (A1 group) compared with 2 per day (A2 group) and equivalent sham sessions (once a day, S1 group; twice a day, S2 group) in patients with treatment-resistant major depression with a subsequent 2-week follow-up period. One hundred seventy-seven patients were screened, of whom 105 met eligibility criteria and 98 consented and were randomized. The HF-rTMS (20 Hz) was targeted to the left prefrontal cortex in sessions of approximately 40 trains (2 seconds each) at 100% resting motor threshold with an intertrain interval of 1 minute. Treatment response was defined as a 50% or greater decrease in the Hamilton Depression Rating Scale (HDRS) score and/or Clinician Global Impressions-Severity of Illness (CGI-S) score of 3 or less. Remission was defined as HDRS score less than 8 and/or CGI-S score of 2 or less. RESULTS Practically none of the subjects in either sham groups achieved remission. Increased odds of remission were present for CGI-S by stimulating twice rather than once per day (odds ratio [OR] = 1.5, P = 0.018), whereas there was a marginal result for HDRS (OR = 3.9, P = 0.066). Patients who had lower baseline HDRS (OR = 0.75, P = 0.014) and CGI-S scores (OR = 0.18, P = 0.001) were more likely to achieve remission. CONCLUSIONS Twice per day active HF-rTMS might be more effective than once per day active HF-rTMS or sham stimulation.
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Thibaut A, O'Brien AT, Fregni F. Strategies for replacing non-invasive brain stimulation sessions: recommendations for designing neurostimulation clinical trials. Expert Rev Med Devices 2017; 14:633-649. [PMID: 28681660 DOI: 10.1080/17434440.2017.1352470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Despite the potential impact of missed visits on the outcomes of neuromodulation treatments, it is not clear how this issue has been addressed in clinical trials. Given this gap in the literature, we reviewed articles on non-invasive brain stimulation in participants with depression or chronic pain, and investigated how missed visits were handled. Areas covered: We performed a search on PUBMED/MEDLINE using the keywords: 'tDCS', 'transcranial direct current stimulation', 'transcranial magnetic stimulation', 'depression', and 'pain'. We included studies with a minimum of five participants who were diagnosed with depression or chronic pain, who underwent a minimum of five tDCS or TMS sessions. A total of 181 studies matched our inclusion criteria, 112 on depression and 69 on chronic pain. Of these, only fifteen (8%) articles reported or had a protocol addressing missed visits. This review demonstrates that, in most of the trials, there is no reported plan to handle missed visits. Expert commentary: Based on our findings and previous studies, we developed suggestions on how to handle missed visits in neuromodulation protocols. A maximum of 20% of missing sessions should be allowed before excluding a patient and these sessions should be replaced at the end of the stimulation period.
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Affiliation(s)
- Aurore Thibaut
- a Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA
| | - Anthony Terrence O'Brien
- a Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA
| | - Felipe Fregni
- a Neuromodulation Center, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation , Harvard Medical School , Boston , MA , USA
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21
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A Comparison of Right Unilateral and Sequential Bilateral Repetitive Transcranial Magnetic Stimulation for Major Depression: A Naturalistic Clinical Australian Study. J ECT 2017; 33:58-62. [PMID: 27753761 DOI: 10.1097/yct.0000000000000359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND A great deal of research has established the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. However, questions remain about the optimal method to deliver treatment. One area requiring consideration is the difference in efficacy between bilateral and unilateral treatment protocols. OBJECTIVE This study aimed to compare the effectiveness of sequential bilateral rTMS and right unilateral rTMS. METHODS A total of 135 patients participated in the study, receiving either bilateral rTMS (N = 57) or right unilateral rTMS (N = 78). Treatment response was assessed using the Hamilton depression rating scale. RESULTS Sequential bilateral rTMS had a higher response rate than right unilateral (43.9% vs 30.8%), but this difference was not statistically significant. This was also the case for remission rates (33.3% vs 21.8%, respectively). Controlling for pretreatment severity of depression, the results did not indicate a significant difference between the protocols with regard to posttreatment Hamilton depression rating scale scores. CONCLUSIONS The current study found no statistically significant differences in response and remission rates between sequential bilateral rTMS and right unilateral rTMS. Given the shorter treatment time and the greater safety and tolerability of right unilateral rTMS, this may be a better choice than bilateral treatment in clinical settings.
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How effective is repetitive transcranial magnetic stimulation for bipolar depression? J Affect Disord 2017; 209:270-272. [PMID: 27987405 DOI: 10.1016/j.jad.2016.11.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/22/2016] [Indexed: 12/28/2022]
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Kaminski E, Hoff M, Rjosk V, Steele CJ, Gundlach C, Sehm B, Villringer A, Ragert P. Anodal Transcranial Direct Current Stimulation Does Not Facilitate Dynamic Balance Task Learning in Healthy Old Adults. Front Hum Neurosci 2017; 11:16. [PMID: 28197085 PMCID: PMC5281631 DOI: 10.3389/fnhum.2017.00016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/09/2017] [Indexed: 11/27/2022] Open
Abstract
Older adults frequently experience a decrease in balance control that leads to increased numbers of falls, injuries and hospitalization. Therefore, evaluating older adults’ ability to maintain balance and examining new approaches to counteract age-related decline in balance control is of great importance for fall prevention and healthy aging. Non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) have been shown to beneficially influence motor behavior and motor learning. In the present study, we investigated the influence of tDCS applied over the leg area of the primary motor cortex (M1) on balance task learning of healthy elderly in a dynamic balance task (DBT). In total, 30 older adults were enrolled in a cross-sectional, randomized design including two consecutive DBT training sessions. Only during the first DBT session, either 20 min of anodal tDCS (a-tDCS) or sham tDCS (s-tDCS) were applied and learning improvement was compared between the two groups. Our data showed that both groups successfully learned to perform the DBT on both training sessions. Interestingly, between-group analyses revealed no difference between the a-tDCS and the s-tDCS group regarding their level of task learning. These results indicate that the concurrent application of tDCS over M1 leg area did not elicit DBT learning enhancement in our study cohort. However, a regression analysis revealed that DBT performance can be predicted by the kinematic profile of the movement, a finding that may provide new insights for individualized approaches of treating balance and gait disorders.
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Affiliation(s)
- Elisabeth Kaminski
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Maike Hoff
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Viola Rjosk
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Christopher J Steele
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany; Department of Psychiatry, Cerebral Imaging Centre, Douglas Mental Health Institute, McGill UniversityMontreal, QC, Canada
| | - Christopher Gundlach
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany; Faculty of Psychology, Department of Experimental Psychology and Methods, University of LeipzigLeipzig, Germany
| | - Bernhard Sehm
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences Leipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany; Mind and Brain Institute, Charité and Humboldt UniversityBerlin, Germany
| | - Patrick Ragert
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany; Faculty of Sport Science, Institute for General Kinesiology and Exercise Science, University of LeipzigLeipzig, Germany
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Assessing the Effects of Repetitive Transcranial Magnetic Stimulation on Cognition in Major Depressive Disorder Using Computerized Cognitive Testing. J ECT 2016; 32:169-73. [PMID: 26934275 DOI: 10.1097/yct.0000000000000308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES A range of different treatment approaches are available for depression; however, there is an ongoing concern about the cognitive impairment associated with many treatments. This study investigated the effect of treatment with repetitive transcranial magnetic stimulation (rTMS) on cognition in patients with major depressive disorder. Cognition before and after treatment was assessed using a computerized cognitive testing battery, which provided comprehensive assessment across a range of cognitive domains. This was a naturalistic study involving patients attending an outpatient clinical rTMS service. METHODS A total of 63 patients with treatment-resistant depression completed the IntegNeuro cognitive test battery, a well-validated comprehensive computerized assessment tool before and after receiving 18 or 20 treatments of sequential bilateral rTMS. Change in the various cognitive domains was assessed, and analyses were undertaken to determine whether any change in cognition was associated with a change in rating of depression severity. RESULTS There was a significant decrease in Hamilton Depression Rating Scale scores from baseline to posttreatment. There was no decline in performance on any of the cognitive tests. There were significant improvements in maze completion time and the number of errors in the maze task. However, these were accounted for by improvement in mood when change in depressive symptoms was included as a covariate. CONCLUSIONS This open-label study provides further support for the efficacy and safety of rTMS as a treatment option for people with major depressive disorder in a naturalistic clinical setting. Using a comprehensive, robust computerized battery of cognitive tests, the current study indicated that there was no significant cognitive impairment associated with rTMS and that any improvements in cognitive functioning were associated with a reduction in depressive symptoms.
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Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ, Downar J, Modirrousta M, Patry S, Vila-Rodriguez F, Lam RW, MacQueen GM, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 4. Neurostimulation Treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:561-75. [PMID: 27486154 PMCID: PMC4994792 DOI: 10.1177/0706743716660033] [Citation(s) in RCA: 353] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Neurostimulation Treatments" is the fourth of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 31 questions for 6 neurostimulation modalities: 1) transcranial direct current stimulation (tDCS), 2) repetitive transcranial magnetic stimulation (rTMS), 3) electroconvulsive therapy (ECT), 4) magnetic seizure therapy (MST), 5) vagus nerve stimulation (VNS), and 6) deep brain stimulation (DBS). Most of the neurostimulation treatments have been investigated in patients with varying degrees of treatment resistance. CONCLUSIONS There is increasing evidence for efficacy, tolerability, and safety of neurostimulation treatments. rTMS is now a first-line recommendation for patients with MDD who have failed at least 1 antidepressant. ECT remains a second-line treatment for patients with treatment-resistant depression, although in some situations, it may be considered first line. Third-line recommendations include tDCS and VNS. MST and DBS are still considered investigational treatments.
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Affiliation(s)
- Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Simon Patry
- Department of Psychiatry, L'Université Laval, Québec City, Québec
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Multiple sessions of transcranial direct current stimulation and upper extremity rehabilitation in stroke: A review and meta-analysis. Clin Neurophysiol 2016; 127:946-955. [DOI: 10.1016/j.clinph.2015.04.067] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/19/2015] [Accepted: 04/15/2015] [Indexed: 11/21/2022]
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Leggett LE, Soril LJJ, Coward S, Lorenzetti DL, MacKean G, Clement FM. Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in Adult and Youth Populations: A Systematic Literature Review and Meta-Analysis. Prim Care Companion CNS Disord 2015; 17:15r01807. [PMID: 27057417 DOI: 10.4088/pcc.15r01807] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/01/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Between 30% and 60% of individuals with major depressive disorder will have treatment-resistant depression (TRD): depression that does not subside with pharmaceutical treatment. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for TRD. OBJECTIVE To establish the efficacy and optimal protocol for rTMS among adults and youth with TRD. DATA SOURCES Two systematic reviews were conducted: one to determine the efficacy of rTMS for adults with TRD and another to determine the effectiveness of rTMS for youth with TRD. For adults, MEDLINE, Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, and Health Technology Assessment Database were searched from inception until January 10, 2014 with no language restrictions. Terms aimed at capturing the target diagnosis, such as depression and depressive disorder, were combined with terms describing the technology, such as transcranial magnetic stimulation and rTMS. Results were limited to studies involving human participants and designed as a randomized controlled trial. For youth, the search was altered to include youth only (aged 13-25 years) and all study designs. When possible, meta-analysis of response and remission rates was conducted. STUDY SELECTION Seventy-three articles were included in this review: 70 on adult and 3 on youth populations. RESULTS Meta-analysis comparing rTMS and sham in adults found statistically significant results favoring rTMS for response (RR: 2.35 [95% CI, 1.70-3.25]) and remission (RR: 2.24 [95% CI, 1.53-3.27]). No statistically significant differences were found when comparing high- and low-frequency, unilateral and bilateral, low- and high-intensity rTMS or rTMS and electroconvulsive therapy (ECT). While meta-analysis of results from the youth literature was not possible, the limited evidence base suggests that rTMS may be effective for treating TRD in youth. CONCLUSIONS The evidence available on the use of rTMS for adults with TRD indicates that rTMS is approximately twice as effective as a sham procedure, although the optimal rTMS protocol remains unclear. Evidence also indicates that rTMS is as effective as ECT and appears promising as a treatment for youth with TRD; however, the evidence base is underdeveloped.
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Affiliation(s)
- Laura E Leggett
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Lesley J J Soril
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Coward
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Diane L Lorenzetti
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada
| | - Gail MacKean
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Fiona M Clement
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Galletly CA, Clarke P, Carnell BL, Gill S. A clinical repetitive transcranial magnetic stimulation service in Australia: 6 years on. Aust N Z J Psychiatry 2015; 49:1040-7. [PMID: 26508800 DOI: 10.1177/0004867415607985] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is considerable research evidence for the effectiveness of repetitive transcranial magnetic stimulation in the treatment of depression. However, there is little information about its acceptability and outcomes in clinical settings. METHOD This naturalistic study reports on a clinical repetitive transcranial magnetic stimulation service that has been running in Adelaide, South Australia (SA), for 6 years. During this time, 214 complete acute courses were provided to patients with treatment-resistant Major Depressive Disorder. Patients received either sequential bilateral or right unilateral repetitive transcranial magnetic stimulation treatment involving either 18 or 20 sessions given over 6 or 4 weeks respectively. Data included patient demographic details, duration of depression, and medication at the beginning of their repetitive transcranial magnetic stimulation course. The Hamilton Depression Rating Scale was used to assess response to repetitive transcranial magnetic stimulation. RESULTS Of those undergoing a first-time acute treatment course of repetitive transcranial magnetic stimulation (N = 167), 28% achieved remission, while a further 12% met the criteria for a response to treatment. Most patients (N = 123, 77%) had previously been treated with five or more antidepressant medications, and 77 (47%) had previously received electroconvulsive therapy. Referral rates remained high over the 6 years, indicating acceptance of the treatment by referring psychiatrists. There were no significant adverse events, and the treatment was generally well tolerated. In all, 41 patients (25%) had a second course of repetitive transcranial magnetic stimulation and 6 (4%) patients had a third course; 21 patients subsequently received maintenance repetitive transcranial magnetic stimulation. CONCLUSION This naturalistic study showed that repetitive transcranial magnetic stimulation was well accepted by both psychiatrists and patients, and has good efficacy and safety. Furthermore, repetitive transcranial magnetic stimulation can provide a useful treatment alternative as part of outpatient mental health services for people with depression.
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Affiliation(s)
- Cherrie A Galletly
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Patrick Clarke
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Benjamin L Carnell
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Shane Gill
- The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia South Australian Psychiatry Training Committee, Central Adelaide Local Health Network - Mental Health Directorate, Adelaide, SA, Australia
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Lepping P, Schönfeldt-Lecuona C, Sambhi RS, Lanka SVN, Lane S, Whittington R, Leucht S, Poole R. A systematic review of the clinical relevance of repetitive transcranial magnetic stimulation. Acta Psychiatr Scand 2014; 130:326-41. [PMID: 24724996 DOI: 10.1111/acps.12276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is an approved treatment for depression. The clinical relevance of its efficacy is unclear. The clinical relevance of findings in the rTMS literature was assessed by translating Hamilton Depression Rating Scale (HAMD) data into Clinical Global Impression-Improvement scale (CGI-I) scores. METHOD We performed electronic searches of MEDLINE, Embase, PsycINFO, PubMed and Cochrane Central Register of Controlled Trials for RCTs and non-RCT trials on rTMS using Hamilton Depression Rating Scale (HAMD). Articles were included if published in English before January 2014. We translated HAMD scores into nominal CGI-I scores for rTMS for depression and for treatment-resistant depression (TRD). RESULTS About 960 abstracts were retrieved. Sixty-three studies were included, yielding 130 study arms. For depression, the mean percentage change in HAMD scores in all sham-controlled rTMS treatment arms was 35.63 (SD 16.35) and for sham-rTMS 23.33 (SD 16.51). For TRD, active rTMS in sham-controlled studies showed a mean HAMD percentage reduction of 45.21 (SD 10.94) versus 25.04 (SD 17.55) for sham-rTMS. When aggregated scores were translated into notional CGI-I scores, for the treatment of depression, the notional CGI-I score difference between rTMS and sham-rTMS was 0.5 in favour of rTMS; for TRD, it was 0.75 in favour of rTMS. Differences between rTMS and sham-rTMS were bigger when all study arms were combined. CONCLUSION Whilst rTMS appears to be efficacious for both non-refractory and treatment-resistant depression, the clinical relevance of its efficacy is doubtful.
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Affiliation(s)
- P Lepping
- Department of Psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK; Centre for Mental Health and Society, Bangor University, Wrexham, Wales, UK
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Burton C, Gill S, Clarke P, Galletly C. Maintaining remission of depression with repetitive transcranial magnetic stimulation during pregnancy: a case report. Arch Womens Ment Health 2014; 17:247-50. [PMID: 24638141 DOI: 10.1007/s00737-014-0418-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/02/2014] [Indexed: 11/28/2022]
Abstract
It is important to explore potential safe treatment options for the ongoing treatment of women's depression during pregnancy. One promising treatment is repetitive transcranial magnetic stimulation (rTMS). We report on the case of a woman who became pregnant while receiving regular maintenance rTMS combined with pharmacotherapy treatment for major depressive episode. The patient achieved remission following two acute courses of rTMS and continued with maintenance rTMS treatment over the course of 4 years, during which she became pregnant and gave birth to a healthy infant. Her remission was maintained over this time including during and after her pregnancy. There were no adverse effects to the patient or her infant during the pregnancy or in the post-natal period. Maintenance rTMS may be an effective and feasible treatment option for depression during pregnancy.
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Affiliation(s)
- Cassandra Burton
- Ramsay Healthcare (SA) Mental Health Services, 33 Park Tce, Gilberton, SA, 5081, Australia,
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Malavera M, Silva F, García R, Rueda L, Carrillo S. [Fundamentals and Clinical Applications of Transcranial Magnetic Stimulation in Neuropsychiatry]. REVISTA COLOMBIANA DE PSIQUIATRIA 2014; 43:32-39. [PMID: 26573254 DOI: 10.1016/s0034-7450(14)70040-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 07/18/2013] [Indexed: 06/05/2023]
Abstract
Transcranial Magnetic Stimulation (TMS) is a non-invasive method for stimulation of brain that is based on the ability of a generated magnetic field to penetrate skull and brain meninges, inducing an electric current in the brain tissues that produces neuronal depolarization. TMS can be applied as single pulse of stimulation, pairs of stimuli separated by variable intervals to the same or different brain areas, or as trains of repetitive stimuli at various frequencies. Its mechanism of action is currently unknown. Repetitive TMS can modify the excitability of the cerebral cortex, and has been postulated as a diagnostic and therapeutic tool in the area of neuropsychiatry. The aim of this article is to review the knowledge of the TMS as regards its basic principles, pathophysiological mechanism, and its usefulness in clinical practice.
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Affiliation(s)
- Mayra Malavera
- Médico, Grupo de Ciencias Neurovasculares, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Federico Silva
- Médico Neurólogo y Epidemiólogo Clínico, Director Neurociencias, Director de la Unidad de Estudios Clínicos, Director Grupo Ciencias Neurovasculares, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.
| | - Ronald García
- PhD en Neurociencias, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, Estados Unidos; Escuela de Medicina, Universidad de Santander, Bucaramanga, Colombia
| | - Ligia Rueda
- Médico psiquiatra, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Sandra Carrillo
- Médico neurólogo, Especialista en Neurofisiología, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
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Transcranial Magnetic Stimulation (TMS) Clinical Applications: Therapeutics. TRANSCRANIAL MAGNETIC STIMULATION 2014. [DOI: 10.1007/978-1-4939-0879-0_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kedzior KK, Azorina V, Reitz SK. More female patients and fewer stimuli per session are associated with the short-term antidepressant properties of repetitive transcranial magnetic stimulation (rTMS): a meta-analysis of 54 sham-controlled studies published between 1997-2013. Neuropsychiatr Dis Treat 2014; 10:727-56. [PMID: 24855360 PMCID: PMC4019615 DOI: 10.2147/ndt.s58405] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) appears to have short-term antidepressant properties. The aim of the current study was to update our previous meta-analysis and to investigate factors associated with the antidepressant properties of rTMS. METHOD Following a systematic literature search conducted in Medline and PsycInfo, N=14 sham-controlled, parallel design studies (published after 2008 to August 2013) that had utilized rTMS of the DLPFC in major depression were included in the current meta-analysis. The sensitivity and moderator analyses also included data from N=40 studies (published in 1997-2008) from our previous meta-analysis. The effect size (Cohen's d) in each study was the standardized difference in mean depression scores (on Hamilton Depression Rating Scale, Beck Depression Inventory, Montgomery Åsberg Depression Rating Scale) from baseline to final (after last session) in rTMS compared to sham groups. RESULTS According to a random-effects model with inverse-variance weights, depression scores were significantly reduced after rTMS compared to sham in studies published from 2008-2013 based on N=659 patients (overall mean weighted d=-0.42, 95% confidence interval: -0.66, -0.18, P=0.001). Combining studies from our past and current meta-analyses (published in 1997-2013; N=54) revealed that depression was significantly reduced after left-fast (>1 Hz), right-slow (≤1 Hz), and bilateral (or sequential) rTMS of DLPFC compared to sham. Significant antidepressant properties of rTMS were observed in studies with patients who were treatment resistant, unipolar (or bipolar), non-psychotic, medication-free (or started on antidepressants concurrently with rTMS). According to univariate meta-regressions, depression scores were significantly lower in studies with more female patients and fewer stimuli per session. There was little evidence that publication bias occurred in the analysis. CONCLUSION According to this study, the largest meta-analysis to date, short-term antidepressant properties of rTMS are independent of concurrent antidepressants and might depend on sex and the number of stimuli per session.
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Affiliation(s)
| | - Valeriya Azorina
- School of Engineering and Science, Jacobs University Bremen, Bremen, Germany
| | - Sarah Kim Reitz
- School of Humanities and Social Sciences, Jacobs University Bremen, Bremen, Germany
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Intensive HF-rTMS treatment in refractory medication-resistant unipolar depressed patients. J Affect Disord 2013; 151:625-631. [PMID: 23896317 DOI: 10.1016/j.jad.2013.07.008] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Major depression is a worldwide severe mental health problem. Unfortunately, not all depressed patients respond to pharmacotherapy or psychotherapy, even when adhering to treatment guidelines. Even though current guidelines do not in particular advocate repetitive Transcranial Magnetic Stimulation (rTMS) in refractory treatment resistant depression (TRD), using more intensive stimulation parameters might hold promise as a valuable alternative. OBJECTIVE Consequently, in this randomized sham-controlled crossover study, we wanted to evaluate clinical outcome of intensive HF-rTMS treatment in TRD when applied to the left dorsolateral prefrontal cortex (DLPFC). METHODS After a 2-week antidepressant washout, 20 unipolar TRD patients, at least stage III, received 20 sham-controlled high-frequency (HF)-rTMS sessions, in a crossover design. Five daily suprathreshold HF-rTMS sessions were spread over four successive days delivering in total 31,200 stimuli. RESULTS Overall, the procedure resulted in immediate statistical significant decreases in depressive symptoms regardless of order/type of stimulation (real/sham), suggesting possible placebo responses. On the other hand, albeit only 35% (7/20) of the patients showed a 50% reduction of their initial Hamilton Depression rating score at the end of the two-week procedure, all these patients showed a prompt clinical response after real HF-rTMS treatment, not after sham. Furthermore, a shorter duration of the current depressive episode was a predictor for beneficial clinical outcome. Unresponsiveness to former ECT could be indicative for negative clinical outcome in these kinds of patients. LIMITATIONS Single center setup with relatively small sample size and no follow-up. CONCLUSIONS Our findings indicate that intensive HF-rTMS treatment might have the potential to result in fast clinical response when confronted with a refractory TRD patient.
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Ciobanu C, Girard M, Marin B, Labrunie A, Malauzat D. rTMS for pharmacoresistant major depression in the clinical setting of a psychiatric hospital: effectiveness and effects of age. J Affect Disord 2013; 150:677-81. [PMID: 23673085 DOI: 10.1016/j.jad.2013.03.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 03/28/2013] [Accepted: 03/28/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive method of brain stimulation used in the treatment of drug-resistant major depressive disorder (MDD). It has been suggested that the efficacy of rTMS decreases with the age of the patient, but the data are contradictory. Here, we analyze in our clinical setting the efficacy of a 3-week rTMS treatment in drug-resistant MDD during a 3 month period and the potential influence of age on this efficacy. METHODS Stimulation consisted of 15 sessions of rTMS over the dorsolateral prefrontal cortex. Clinical evaluations included the Hamilton Depression Rating Scale (HDRS), and the Beck Depression Inventory (BDI) at baseline, after 3 weeks of treatment, and 1 month and 3 months after the last session. RESULTS Data from 93 patients issued from the 178 patients active file were analyzed. The antidepressant effect observed in the two age groups (<65 and ≥65) did not differ at the end of the treatment and 3 months later, with a comparable number of responders (50% decrease in HDRS score from baseline) (53.3% for age <65 versus 46.7% for age ≥65, p=0.51). The treatment had a significant effect over time. We found no evidence of the age affecting outcome at 3 months after the last session. LIMITATIONS Previous antidepressant treatments, and therapeutic drug use modifications after rTMS treatment, degree of pharmaco-resistance or duration of current episode are not reported. CONCLUSION RTMS of the DFPLC is effective as an add-on treatment for cases of pharmacologically refractory major depression, independent of the patient age.
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Affiliation(s)
- Cristina Ciobanu
- Département Recherche et Développement, Centre Hospitalier Esquirol, 15 rue du Docteur Marcland, 87025 Limoges cedex, France
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Speer AM, Wassermann EM, Benson BE, Herscovitch P, Post RM. Antidepressant efficacy of high and low frequency rTMS at 110% of motor threshold versus sham stimulation over left prefrontal cortex. Brain Stimul 2013; 7:36-41. [PMID: 23928104 DOI: 10.1016/j.brs.2013.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 07/08/2013] [Accepted: 07/08/2013] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND While the efficacy of repetitive transcranial magnetic stimulation (rTMS) at 10 Hz over the left prefrontal cortex has been repeatedly demonstrated, it is not clear that the optimal parameters for the treatment of depression have been adequately elucidated. OBJECTIVES We sought to assess the antidepressant effectiveness of high and low frequency at a higher intensity rTMS compared to sham in patients with moderately treatment resistant depression. METHOD The authors conducted a three-week, double-blind, randomized, sham-controlled study of 24 acutely depressed patients given either active 20 Hz (n = 8) or 1 Hz (n = 8) rTMS (at 110% of motor threshold [MT]) or sham treatments (n = 8) over the left prefrontal cortex. Hamilton Depression ratings were analyzed by ANOVA. RESULTS Patients on both frequencies showed greater improvement than on sham, which was associated with minor increases in depression. During open continuation to allow 7 weeks of active treatment in all individuals, additional improvement was observed. CONCLUSIONS The results seen here using 110% of MT for 3 weeks were more robust than those of previous studies of 1-Hz or 20-Hz rTMS for 2 weeks (at 80% and 100% of MT). The results also raise the possibility that both high and low frequency rTMS over left prefrontal cortex (and not just low frequency over the right prefrontal cortex) exert antidepressant effects, but further work is required to assess what parameters may be most effective in general and for a given individual.
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Affiliation(s)
- Andrew M Speer
- Laboratory of Brain and Cognition, 4804 Montgomery Avenue, Bethesda, MD 20814, USA
| | | | | | | | - Robert M Post
- Bipolar Collaborative Network, 5415 W. Cedar Lane, Suite 201-B, Bethesda, MD 20814, USA.
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Lipsman N, Sankar T, Downar J, Kennedy SH, Lozano AM, Giacobbe P. Neuromodulation for treatment-refractory major depressive disorder. CMAJ 2013; 186:33-9. [PMID: 23897945 DOI: 10.1503/cmaj.121317] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Downar J, Daskalakis ZJ. New Targets for rTMS in Depression: A Review of Convergent Evidence. Brain Stimul 2013; 6:231-40. [DOI: 10.1016/j.brs.2012.08.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 01/12/2023] Open
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Baker PL, Trevino K, McClintock SM, Wani A, Husain MM. Clinical applications of electroconvulsive therapy and transcranial magnetic stimulation for the treatment of major depressive disorder: a critical review. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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