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O'Sullivan SJ, Buchanan DM, Batail JMV, Williams NR. Should rTMS be considered a first-line treatment for major depressive episodes in adults? Clin Neurophysiol 2024; 165:76-87. [PMID: 38968909 DOI: 10.1016/j.clinph.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/16/2024] [Accepted: 06/10/2024] [Indexed: 07/07/2024]
Abstract
Treatment-resistant depression (TRD) is an epidemic with rising social, economic, and political costs. In a patient whose major depressive episode (MDE) persists through an adequate antidepressant trial, insurance companies often cover alternative treatments which may include repetitive transcranial magnetic stimulation (rTMS). RTMS is an FDA-cleared neuromodulation technique for TRD which is safe, efficacious, noninvasive, and well-tolerated. Recent developments in the optimization of rTMS algorithms and targeting have increased the efficacy of rTMS in treating depression, improved the clinical convenience of these treatments, and decreased the cost of a course of rTMS. In this opinion paper, we make a case for why conventional FDA-cleared rTMS should be considered as a first-line treatment for all adult MDEs. RTMS is compared to other first-line treatments including psychotherapy and SSRIs. These observations suggest that rTMS has similar efficacy, fewer side-effects, lower risk of serious adverse events, comparable compliance, the potential for more rapid relief, and cost-effectiveness. This suggestion, however, would be strengthened by further research with an emphasis on treatment-naive subjects in their first depressive episode, and trials directly contrasting rTMS with SSRIs or psychotherapy.
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Affiliation(s)
- Sean J O'Sullivan
- Department of Psychiatry and Behavioral Sciences, Dell School of Medicine, Austin, TX, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA. USA.
| | - Derrick M Buchanan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA. USA
| | - Jean-Marie V Batail
- Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Centre Hospitalier Guillaume Régnier, Rennes, France; Université de Rennes, Rennes, France
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA. USA
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Speranza BE, Hill AT, Do M, Cerins A, Donaldson PH, Desarkar P, Oberman LM, Das S, Enticott PG, Kirkovski M. The Neurophysiological Effects of Theta Burst Stimulation as Measured by Electroencephalography: A Systematic Review. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00206-4. [PMID: 39084526 DOI: 10.1016/j.bpsc.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/10/2024] [Accepted: 07/21/2024] [Indexed: 08/02/2024]
Abstract
Theta burst stimulation (TBS) is a non-invasive brain stimulation technique that can modulate neural activity. The effect of TBS on regions beyond the motor cortex remains unclear. With increased interest in applying TBS to non-motor regions for research and clinical purposes, these effects must be understood and characterised. We synthesised the electrophysiological effects of a single session of TBS, as indexed by electroencephalography (EEG) and concurrent transcranial magnetic stimulation and EEG (TMS-EEG), in non-clinical participants. We reviewed 79 studies that administered either continuous TBS (cTBS) or intermittent TBS (iTBS) protocols. Broadly, cTBS suppressed and iTBS facilitated evoked response component amplitudes. Response to TBS as measured by spectral power and connectivity was much more variable. Variability increased in the presence of task stimuli. There was a large degree of heterogeneity in the research methodology across studies. Additionally, the effect of individual differences on TBS response is insufficiently investigated. Future research investigating the effects of TBS as measured by EEG must consider methodological and individual factors that may affect TBS outcomes.
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Affiliation(s)
- Bridgette E Speranza
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia.
| | - Aron T Hill
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Michael Do
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Andris Cerins
- Brain Stimulation Lab, Alfred Psychiatry Research Centre, Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Australia; Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Peter H Donaldson
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Pushpal Desarkar
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lindsay M Oberman
- Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Sushmit Das
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter G Enticott
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia
| | - Melissa Kirkovski
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Burwood, Victoria, Australia; Institute for Health and Sport, Victoria University, Melbourne, Australia
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Bastiaens J, Brown N, Bermudes RA, Juusola JL, Bravata DM, Marton TF. Utilization and outcomes of transcranial magnetic stimulation and usual care for MDD in a large group psychiatric practice. BMC Psychiatry 2024; 24:497. [PMID: 38982458 PMCID: PMC11234753 DOI: 10.1186/s12888-024-05928-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/23/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND General psychiatrists' practice standards vary regarding when to implement transcranial magnetic stimulation (TMS) for care of patients with major depressive disorder (MDD). Furthermore, few studies have examined real-world utilization and clinical outcomes of TMS. This study analyzed data from a large, multi-site psychiatric practice to evaluate utilization and outcomes of TMS as well as usual care (UC) for patients with MDD. METHODS Depression outcomes for TMS and UC among adult patients at a multi-site psychiatric group practice were examined in this retrospective cohort analysis. Patients with a primary diagnosis of MDD, PHQ-9 ≥ 10, and a visit in November 2020 with 6-month follow-up were included and categorized into the TMS or UC cohorts. RESULTS Of 1,011 patients with qualifying PHQ-9 at the baseline visit, 9% (89) received a full course of TMS, and 583 patients receiving UC met study inclusion criteria (339 patients were excluded due to lacking a 6-month follow-up visit or receiving esketamine during the study period). The TMS cohort had higher baseline PHQ-9 than UC (17.9 vs. 15.5, p < .001) and had failed more medication trials (≥ 4 vs. 3.1, p < .001). Mean PHQ-9 decreased by 5.7 points (SD = 6.7, p < .001) in the TMS cohort and by 4.2 points (SD = 6.4, p < .001) in the UC cohort over the study period. Among patients who had failed four or more antidepressant medications, PHQ-9 decreased by 5.8 points in the TMS cohort (SD = 6.7, p < .001) and by 3.2 points in the UC cohort (SD = 6.3, p < .001). CONCLUSIONS TMS utilization was low, despite TMS showing significant real-world clinical benefits. Future research should examine and address barriers to wider adoption of TMS into routine patient care for patients with treatment-resistant MDD. Wider adoption including routine use of TMS in less treatment-resistant patients will allow statistical comparisons of outcomes between TMS and UC populations that are difficult to do when TMS is underutilized.
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Affiliation(s)
- Jesse Bastiaens
- Mindful Health Solutions, 360 Post St #500, San Francisco, CA, 94108, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Natalie Brown
- Mindful Health Solutions, 360 Post St #500, San Francisco, CA, 94108, USA
| | - Richard A Bermudes
- Mindful Health Solutions, 360 Post St #500, San Francisco, CA, 94108, USA
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | | | - Dena M Bravata
- Mindful Health Solutions, 360 Post St #500, San Francisco, CA, 94108, USA
- Center for Primary Care & Outcomes Research, Stanford University, Palo Alto, CA, USA
| | - Tobias F Marton
- Mindful Health Solutions, 360 Post St #500, San Francisco, CA, 94108, USA.
- Department of Psychiatry, University of California, San Francisco, CA, USA.
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Zoicas I, Licht C, Mühle C, Kornhuber J. Repetitive transcranial magnetic stimulation (rTMS) for depressive-like symptoms in rodent animal models. Neurosci Biobehav Rev 2024; 162:105726. [PMID: 38762128 DOI: 10.1016/j.neubiorev.2024.105726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) emerged as a non-invasive brain stimulation technique in the treatment of psychiatric disorders. Both preclinical and clinical studies as well as systematic reviews provide a heterogeneous picture, particularly concerning the stimulation protocols used in rTMS. Here, we present a review of rTMS effects in rodent models of depressive-like symptoms with the aim to identify the most relevant factors that lead to an increased therapeutic success. The influence of different factors, such as the stimulation parameters (stimulus frequency and intensity, duration of stimulation, shape and positioning of the coil), symptom severity and individual characteristics (age, species and genetic background of the rodents), on the therapeutic success are discussed. Accumulating evidence indicates that rTMS ameliorates a multitude of depressive-like symptoms in rodent models, most effectively at high stimulation frequencies (≥5 Hz) especially in adult rodents with a pronounced pathological phenotype. The therapeutic success of rTMS might be increased in the future by considering these factors and using more standardized stimulation protocols.
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Affiliation(s)
- Iulia Zoicas
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Psychiatry and Psychotherapy, Schwabachanlage 6, Erlangen 91054, Germany.
| | - Christiane Licht
- Paracelsus Medical University, Department of Psychiatry and Psychotherapy, Prof.-Ernst-Nathan-Str. 1, Nürnberg 90419, Germany
| | - Christiane Mühle
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Psychiatry and Psychotherapy, Schwabachanlage 6, Erlangen 91054, Germany
| | - Johannes Kornhuber
- Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Psychiatry and Psychotherapy, Schwabachanlage 6, Erlangen 91054, Germany
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Hayashi D, Yamazaki R, Matsuda Y, Igarashi S, Taruishi N, Kodaka F, Shigeta M, Kito S. Association between Stimulation-Site Pain and Clinical Improvement during Repetitive Transcranial Magnetic Stimulation for Patients with Major Depressive Disorders: A Prospective Observational Study at Two Sites. Neuropsychobiology 2024:1-8. [PMID: 38889691 DOI: 10.1159/000538971] [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: 10/15/2023] [Accepted: 04/13/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression (TRD) in Japan has not been adequately investigated. Furthermore, the relationship between stimulation-site pain and the antidepressant effects of rTMS has not been thoroughly examined. Therefore, this study aimed to clarify (1) the real-world efficacy and safety of rTMS for TRD in Japan and (2) the relationship between stimulation-site pain and clinical improvement of depressive symptoms. METHODS We conducted a retrospective observational study involving 50 right-handed patients with TRD. All patients received high-frequency rTMS for up to 6 weeks. Depressive symptoms were assessed using the Montgomery-Åsberg depression rating scale (MADRS). Pain at the stimulation site was reported by the patients using a visual analog scale (VAS) after each session. Remission and response rates at 3 and 6 weeks were calculated based on the MADRS scores. The correlation between changes in the MADRS and VAS scores was examined. RESULTS Remission and response rates were 36% and 46%, respectively, at the end of 3 weeks, and 60% and 70%, respectively, at 6 weeks. At the end of the treatment, there was significant correlation between the reduction of MADRS and VAS scores (r = 0.42, p = 0.003). CONCLUSION This study demonstrates the clinical efficacy of rTMS in Japan and the correlation between its antidepressant effects and stimulation-site pain.
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Affiliation(s)
- Daisuke Hayashi
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ryuichi Yamazaki
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Matsuda
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Igarashi
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Nanase Taruishi
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumitoshi Kodaka
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinsuke Kito
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
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Parker G, Tavella G, Spoelma MJ, Sazhin V. Does theta burst stimulation have differential benefit for those with melancholic or non-melancholic depression? J Affect Disord 2024; 350:847-853. [PMID: 38272362 DOI: 10.1016/j.jad.2024.01.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND To determine if theta burst stimulation (TBS) is of preferential benefit to those with melancholic or non-melancholic depression as an adjunctive treatment for treatment resistant depression (TRD). METHODS Fifty-two patients receiving TBS at a private psychiatric hospital participated in a naturalistic study. Four diagnostic strategies were used to assign melancholic versus non-melancholic depression subtype status. Depression symptoms were assessed at baseline, mid-treatment, and end of treatment using the Montgomery-Ǻsberg Depression Rating Scale - Self-Assessment (MADRS-S). Forty-one participants also completed the MADR-S at a six-week follow-up assessment. RESULTS We quantified poor correlations between the four study measures of melancholia; a finding suggesting that valid measurement of melancholia is likely to remain problematic. TBS led to significant reductions in depression symptoms from baseline to end of treatment, with this effect maintained at follow up. Response rates for the whole sample were 61.5 % at end of treatment and 53.7 % at follow-up, while remission rates were 34.6 % at end of treatment and 31.7 % at follow-up. Improvement rates as well as responder and remission rates were comparable for the melancholic and non-melancholic groups, irrespective of the diagnostic strategy used. LIMITATIONS The study was naturalistic (i.e., there being no control group, and concomitant medication changes were allowed), depression severity was assessed only by use of self-report measures, and the sample size was relatively small. CONCLUSION TBS appears to be non-specific, in that we failed to quantify any statistically significant differential benefit for those with melancholic compared to those with non-melancholic depression.
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Affiliation(s)
- Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia; Gordon Private Hospital, Gordon, Sydney, Australia.
| | - Gabriela Tavella
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Michael J Spoelma
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia; Black Dog Institute, Sydney, Australia
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Yuan Q, Lei Y, Yu K, Wu J, Xu Z, Wen C, Liu Y, Wang W, He J. Repetitive transcranial magnetic stimulation and fluoxetine attenuate astroglial activation and benefit behaviours in a chronic unpredictable mild stress mouse model of depression. World J Biol Psychiatry 2024; 25:82-94. [PMID: 37942712 DOI: 10.1080/15622975.2023.2279958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
Objectives: Repetitive transcranial magnetic stimulation (rTMS) has been considered as an effective antidepressant treatment; however, the mechanism of its antidepressant effect is still unclear. Fluoxetine, a selective serotonin reuptake inhibitor antidepressant, may be neuroprotective. The objective of the present study was to evaluate the effect and underlying possible neuroprotective mechanism of rTMS and fluoxetine on abnormal behaviours in a depressive mouse model induced by chronic unpredictable mild stress (CUMS).Methods: After 28 days of CUMS exposure, mice were chronically treated with rTMS (10 Hz for 5 s per train, total 20 trains per day) and (or) fluoxetine (5 mg/kg/day, intraperitoneally) for 28 days targeting on the frontal cortex. After the behavioural tests, the protein expressions of glial fibrillary acidic protein (GFAP), brain-derived neurotrophic factor (BDNF) and tyrosine kinase B (TrkB) were measured by immunohistochemistry and (or) Western Blot.Results: The results showed rTMS and (or) fluoxetine attenuated the locomotion decrease, anxiety and depressive like behaviours in the CUMS-exposed mice.Conclusion: Our results suggest that both rTMS and fluoxetine could benefit the CUMS-induced abnormal behaviours including depressive-like behaviours, and the beneficial effects of rTMS as well as fluoxetine on depression might be partly related to their neuroprotective effect on attenuating astroglial activation and BDNF decrease.
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Affiliation(s)
- Qianfa Yuan
- Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Xiamen Xian Yue Hospital, Xian Yue Hospital Affiliated with Xiamen Medical College, Xiamen, Fujian, China
| | - Yuying Lei
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kai Yu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junnan Wu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhizhong Xu
- Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Xiamen Xian Yue Hospital, Xian Yue Hospital Affiliated with Xiamen Medical College, Xiamen, Fujian, China
| | - Chunyan Wen
- Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Xiamen Xian Yue Hospital, Xian Yue Hospital Affiliated with Xiamen Medical College, Xiamen, Fujian, China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
- The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenqiang Wang
- Fujian Psychiatric Center, Fujian Clinical Research Center for Mental Disorders, Xiamen Xian Yue Hospital, Xian Yue Hospital Affiliated with Xiamen Medical College, Xiamen, Fujian, China
| | - Jue He
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, China
- The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Neurological Disease, First Affiliated Hospital, Henan University, Kaifeng, Henan, China
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Roth Y, Munasifi F, Harvey SA, Grammer G, Hanlon CA, Tendler A. Never Too Late: Safety and Efficacy of Deep TMS for Late-Life Depression. J Clin Med 2024; 13:816. [PMID: 38337509 PMCID: PMC10856385 DOI: 10.3390/jcm13030816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective and well-established treatment for major depressive disorder (MDD). Deep TMS utilizes specially designed H-Coils to stimulate the deep and broad cerebral regions associated with the reward system. The improved depth penetration of Deep TMS may be particularly important in late-life patients who often experience brain atrophy. The aim of this phase IV open-label study was to evaluate the safety and efficacy of Deep TMS in patients with late-life MDD. Data were collected from 247 patients with MDD aged 60-91 at 16 sites who had received at least 20 Deep TMS sessions for MDD. The outcome measures included self-assessment questionnaires (Patient Health Questionnaire-9 (PHQ-9), Beck Depression Inventory-II (BDI-II)) and clinician-based scales (21-item Hamilton Depression Rating Scale (HDRS-21)). Following 30 sessions of Deep TMS, there was a 79.4% response and 60.3% remission rate on the most rated scale. The outcomes on the PHQ-9 were similar (76.6% response and 54.7% remission rate). The highest remission and response rates were observed with the HDRS physician-rated scale after 30 sessions (89% response and a 78% remission rate). After 20 sessions, there was a 73% response and 73% remission rate on the HDRS. Consistent with prior studies, the median onset of response was 14 sessions (20 days). The median onset of remission was 15 sessions (23 days). The treatment was well tolerated, with no reported serious adverse events. These high response and remission rates in patients with treatment-resistant late-life depression suggest that Deep TMS is a safe, well-tolerated and effective treatment for this expanded age range of older adults.
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Affiliation(s)
- Yiftach Roth
- BrainsWay Ltd., Jerusalem 9777518, Israel; (Y.R.); (C.A.H.)
- Department of Life Sciences, Ben Gurion University, Beer Sheba 84990, Israel
| | - Faisal Munasifi
- Tallahassee Brain Stimulation Center, LLC, 1407 MD Lane, Tallahassee, FL 32308, USA;
| | - Steven A. Harvey
- Greenbrook TMS Neurohealth, 16091 Swingley Ridge Rd. Suite 100, Chesterfield, MO 63017, USA;
| | - Geoffrey Grammer
- Greenbrook TMS Neurohealth, 8405 Greensboro Dr #120, McLean, VA 22102, USA;
| | | | - Aron Tendler
- BrainsWay Ltd., Jerusalem 9777518, Israel; (Y.R.); (C.A.H.)
- Department of Life Sciences, Ben Gurion University, Beer Sheba 84990, Israel
- DTMS Center LLC, 1601 Forum Place, West Palm Beach, FL 33401, USA
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Roth Y, Hanlon CA, Pell G, Zibman S, Harmelech T, Muir OS, MacMillan C, Prestley T, Purselle DC, Knightly T, Tendler A. Real world efficacy and safety of various accelerated deep TMS protocols for major depression. Psychiatry Res 2023; 328:115482. [PMID: 37738684 DOI: 10.1016/j.psychres.2023.115482] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/02/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
There is growing interest in accelerated rTMS dosing regimens, wherein multiple sessions of rTMS are applied per day. This Phase IV study evaluated the safety, efficacy, and durability of various accelerated Deep TMS protocols used in clinical practice. Data were aggregated from 111 patients with major depressive disorder (MDD) at 4 sites. Patients received one of several accelerated Deep TMS protocols (2x/day, 3x/day, 5x/day, 10x/day). Self-assessment questionnaires (PHQ-9, BDI-II) and clinician-based rating scales (HDRS-21, MADRS) were collected. On average, accelerated TMS led to an 80.2% response and 50.5% remission rate in the first month based on the most rated scale for each patient. There was no significant difference between protocols (Response: 2x/day:89.6%; 3x/day:75%; 5x/day:81%; 10x/day:67.6%). Response occurred after 10 (3x/day), 20 (5x/day), and 31 sessions (10x/day) on average- all of which occur on day 3-4 of treatment. Of patients with longer term follow up, durability was found in 86.7% (n = 30; 60 days) and 92.9% (n = 14; 180 days). The protocols were well-tolerated with no reported serious adverse events. Accelerated Deep TMS protocols are found to be safe, effective therapeutic options for MDD. They offer treatment resistant patients a treatment option with a rapid onset of action and with long durability.
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Affiliation(s)
- Yiftach Roth
- BrainsWay Ltd. Jerusalem, Israel & Burlington, Suite 405, Burlington, MA 01803, United States; Ben Gurion University, Department of Life Sciences, Beer Sheba, Israel
| | - Colleen A Hanlon
- BrainsWay Ltd. Jerusalem, Israel & Burlington, Suite 405, Burlington, MA 01803, United States; Wake Forest University School of Medicine, Winston Salem, NC, United States
| | - Gaby Pell
- BrainsWay Ltd. Jerusalem, Israel & Burlington, Suite 405, Burlington, MA 01803, United States; Ben Gurion University, Department of Life Sciences, Beer Sheba, Israel
| | - Samuel Zibman
- BrainsWay Ltd. Jerusalem, Israel & Burlington, Suite 405, Burlington, MA 01803, United States
| | - Tal Harmelech
- BrainsWay Ltd. Jerusalem, Israel & Burlington, Suite 405, Burlington, MA 01803, United States
| | - Owen S Muir
- Fermata, 58N, 9th St. #103 Brooklyn, NY, United States
| | - Carlene MacMillan
- Fermata, 58N, 9th St. #103 Brooklyn, NY, United States; Osmind, Inc, 3130 20th St Suite 250, San Francisco, CA, United States
| | - Tim Prestley
- Novus TMS, 2201 Jack Warner Pkwy Tuscaloosa, AL, United States
| | - David C Purselle
- Rejuvenate TMS, 652 Bellemeade Ave NW, Atlanta, GA, United States
| | - Thomas Knightly
- Evolve Brain Health, 1055 Summer St. #2 Stamford, CT, United States
| | - Aron Tendler
- BrainsWay Ltd. Jerusalem, Israel & Burlington, Suite 405, Burlington, MA 01803, United States; Ben Gurion University, Department of Life Sciences, Beer Sheba, Israel.
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10
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Mao J, Fan K, Zhang Y, Wen N, Fang X, Ye X, Chen Y. 10 Hz repetitive transcranial magnetic stimulation (rTMS) may improve cognitive function: An exploratory study of schizophrenia patients with auditory hallucinations. Heliyon 2023; 9:e19912. [PMID: 37809845 PMCID: PMC10559318 DOI: 10.1016/j.heliyon.2023.e19912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/18/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Cognitive impairment in schizophrenia patients with auditory hallucinations is more prominent compared to those without. Our study aimed to investigate the cognitive improvement effects of 10 Hz repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) in schizophrenia with auditory hallucinations. Methods A total of 60 schizophrenic patients with auditory hallucinations in this study were randomly assigned to sham or active group. Both groups received 10 Hz or sham rTMS targeted in left DLPFC for 20 sessions. The Positive and Negative Syndrome Scale (PANSS), the Auditory Hallucination Rating Scale (AHRS), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Udvalg for Kliniske Under-sogelser (UKU) side effect scale were used to measure psychiatric symptoms, auditory hallucinations, cognition, and side reaction, respectively. Results Our results indicated that the active group experienced greater improvements in RBANS-total score (P = 0.043) and immediate memory subscale score (P = 0.001). Additionally, the PANSS-total score, negative and positive subscale score were obviously lower in the active group compared to the sham group (all P < 0.050). Furthermore, our study found that the improvement of RBANS-total score was positively associated with the decline of positive factor score, and the improvement of language score in RBANS was positively associated with the reduction in PANSS-total scale, negative and positive subscale score in the real stimulation group (all P < 0.050). Conclusion Our results demonstrated that a four-week intervention of 10 Hz rTMS over the left DLPFC can improve cognition (particularly immediate memory) among schizophrenia patients with auditory hallucinations. Future studies with larger sample size are needful to verify our preliminary findings.
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Affiliation(s)
- Jiankai Mao
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, PR China
| | - Kaili Fan
- Wenzhou Seventh People's Hospital, Wenzhou, Zhejiang, PR China
| | - Yaoyao Zhang
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, Zhejiang, PR China
| | - Na Wen
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, Zhejiang, PR China
| | - Xinyu Fang
- The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiangming Ye
- Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, PR China
| | - Yi Chen
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, Zhejiang, PR China
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11
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Pridmore S. Medicare Benefits Schedule item numbers for transcranial magnetic stimulation (TMS): Questions arising. Australas Psychiatry 2023; 31:494-496. [PMID: 37128938 PMCID: PMC10466937 DOI: 10.1177/10398562231173228] [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: 05/03/2023]
Abstract
OBJECTIVE Four Medicare Benefits Schedule item numbers for Transcranial Magnetic Stimulation (TMS) treatment of unresponsive MDD were declared in Australia in 2021. They are accompanied by rules/conditions. The aim is to consider these rules/conditions in light of recent research and real-world experience. CONCLUSIONS While evidence supports some listed rules/conditions, others lack clinical justification and deserve to be reconsidered. These include (a) ineligibility of patients who have previously received TMS, (b) a lifetime total limit of 50 treatments, (c) a second/final course being unavailable for 4 months following the completion of the first course, and (d) the second/final course being limited to 15 treatments.
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Affiliation(s)
- Saxby Pridmore
- Department of Psychiatry, University of Tasmania, Hobart, TAS, Australia
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12
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Oppermann H, Thelen A, Haueisen J. Entrainment and resonance effects with a new mobile audio-visual stimulation device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083109 DOI: 10.1109/embc40787.2023.10341051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Entrainment and photic driving effects triggered by repetitive visual stimulation are long-established in clinical and therapeutic scenarios. Nonetheless, such stimulation patterns are typically bound to stationary clinical and laboratory applications. We investigated the effects of repetitive stimulation with a new dynamic auditory-visual stimulation pattern using a novel consumer-grade stimulation device for home application.Fourteen volunteers (study group) received 16 sessions of combined auditory-visual stimulation during four weeks. An additional control group (seven volunteers) received auditory-only stimulation for two sessions. From 64-channel electroencephalography recordings, we compared individual alpha peak frequencies (iAPF) between week one and week four as well as power values from the time-frequency analysis.The novel stimulation device yielded stable entrainment and resonance effects for all investigated stimulation frequencies. Both groups showed no differences in their iAPFs between weeks one and four. The power comparison suggests that there are similar entrainment and resonance effects in week one and week four within the study group.We conclude that the novel portable consumer-grade stimulation device is suitable for home-based auditory-visual stimulation leading to consistent entrainment and resonance effects over the course of 16 stimulation sessions over four weeks.
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13
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İzci EK, Sertdemir M. Role of a Qualified Physician and Health Behavior in Effective Treatment of Cervical Spondylotic Myelopathy. Am J Health Behav 2022; 46:695-705. [PMID: 36721276 DOI: 10.5993/ajhb.46.6.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: This research investigated the impact of having a qualified physician on improving disease awareness and effective treatment for cervical spondylotic myelopathy. Previous studies have observed that patients with cervical spondylotic myelopathy are less satisfied with their treatment and medical facilities. This study hence aimed to investigate the role of a qualified physician and the moderating influence of health behavior between disease awareness and effective treatment for cervical spondylotic myelopathy. Methods: The primary data was collected from 144 cervical spondylotic myelopathy patients admitted in Meram Medical Faculty Hospital. A questionnaire on 5-point Likert scale was developed, whose items were checked for validity and reliability. The study adopted a cross- sectional approach, by conducting a normality test, correlation measurement of all variables like disease awareness, qualified physician and health behavior, and a regression analysis to explore the impact of independent variables on the dependent variable, and to test the hypotheses of the study. Results: The results of this research revealed that patients of cervical spondylotic myelopathy would get effective treatment when their health behavior is positive and when they have an awareness of the critical health situation. Conclusion: This research contributed a framework significantly to the research gap. It demonstrated the extraordinary practical and theoretical implications related to cervical spondylotic myelopathy. Future directions are also recommended by highlighting the limitations of this research, in order to continue to contribute to the effective treatment of cervical spondylotic myelopathy patients.
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14
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Fitzgerald PB, Gill S, Breakspear M, Kulkarni J, Chen L, Pridmore S, Purushothaman S, Galletly C, Clarke P, Ng F, Hussain S, Chamoli S, Csizmadia T, Tolan P, Cocchi L, Ibrahim Oam S, Shankar K, Sarma S, Lau M, Loo C, Yadav T, Hoy KE. Revisiting the effectiveness of repetitive transcranial magnetic stimulation treatment in depression, again. Aust N Z J Psychiatry 2022; 56:905-909. [PMID: 34969310 DOI: 10.1177/00048674211068788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Following on from the publication of the Royal Australian and New Zealand Journal of Psychiatry Mood Disorder Clinical Practice Guidelines (2020) and criticisms of how these aberrantly addressed repetitive transcranial magnetic stimulation treatment of depression, questions have continued to be raised in the journal about this treatment by a small group of authors, whose views we contend do not reflect the broad acceptance of this treatment nationally and internationally. In fact, the evidence supporting the use of repetitive transcranial magnetic stimulation treatment in depression is unambiguous and substantial, consisting of an extensive series of clinical trials supported by multiple meta-analyses, network meta-analysis and umbrella reviews. Importantly, the use of repetitive transcranial magnetic stimulation treatment in depression has also been subject to a series of health economic analyses. These indicate that repetitive transcranial magnetic stimulation is a cost-effective therapy and have been used in some jurisdictions, including Australia, in support of public funding. An argument has been made that offering repetitive transcranial magnetic stimulation treatment may delay potentially effective pharmacotherapy. In fact, there is considerably greater danger of the opposite happening. Repetitive transcranial magnetic stimulation is as, if not more effective, than antidepressant medication after two unsuccessful medication trials and should be a consideration for all patients under these circumstances where available. There is no meaningful ongoing debate about the use of repetitive transcranial magnetic stimulation treatment in depression - it is a safe, effective and cost-effective treatment.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, VIC, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Shane Gill
- The University of Adelaide, Adelaide, SA, Australia.,SAPBTC, Glenside Health Service, Glenside, SA, Australia.,Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Michael Breakspear
- Discipline of Psychiatry, College of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Jayashri Kulkarni
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Leo Chen
- Department of Psychiatry, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia
| | - Saxby Pridmore
- Saint Helens Private Hospital, Hobart, TAS, Australia.,Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | | | - Cherrie Galletly
- Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, 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
| | - Felicity Ng
- Discipline of Psychiatry, The Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia.,The Adelaide Clinic, Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
| | - Salam Hussain
- Section for ECT and Neurostimulation, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia.,The University of Western Australia, Perth, WA, Australia.,Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | | | - Patrick Tolan
- Alfred Health/Peninsula Health, Melbourne, VIC, Australia
| | | | - Samir Ibrahim Oam
- TMS Northpark Private Hospital, Bundoora, VIC, Australia.,Wyndham Private Clinic, Werribee, VIC, Australia
| | - Kavitha Shankar
- TMS Clinics Australia, Sydney, NSW, Australia.,St John of God Pinelodge Clinic, Dandenong, VIC, Australia
| | - Shanthi Sarma
- Bond University, Robina, QLD, Australia.,Gold Coast Health, Southport, QLD, Australia
| | - Michael Lau
- TMS Clinics Australia, Sydney, NSW, Australia.,Monarch Mental Health Group, Sydney, NSW, Australia.,Hornsby Ku-Ring-Gai Adult Mental Health Unit, Hornsby, NSW, Australia
| | - Colleen Loo
- Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Tarun Yadav
- Hunter New England Drug and Alcohol Service, Newcastle, NSW, Australia.,Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate E Hoy
- Epworth Centre for Innovation in Mental Health, Epworth HealthCare, Camberwell, VIC, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
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15
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Current Status of Neuromodulation-Induced Cortical Prehabilitation and Considerations for Treatment Pathways in Lower-Grade Glioma Surgery. LIFE (BASEL, SWITZERLAND) 2022; 12:life12040466. [PMID: 35454957 PMCID: PMC9024440 DOI: 10.3390/life12040466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/19/2022] [Accepted: 03/19/2022] [Indexed: 12/15/2022]
Abstract
The infiltrative character of supratentorial lower grade glioma makes it possible for eloquent neural pathways to remain within tumoural tissue, which renders complete surgical resection challenging. Neuromodulation-Induced Cortical Prehabilitation (NICP) is intended to reduce the likelihood of premeditated neurologic sequelae that otherwise would have resulted in extensive rehabilitation or permanent injury following surgery. This review aims to conceptualise current approaches involving Repetitive Transcranial Magnetic Stimulation (rTMS-NICP) and extraoperative Direct Cortical Stimulation (eDCS-NICP) for the purposes of inducing cortical reorganisation prior to surgery, with considerations derived from psychiatric, rehabilitative and electrophysiologic findings related to previous reports of prehabilitation. Despite the promise of reduced risk and incidence of neurologic injury in glioma surgery, the current data indicates a broad but compelling possibility of effective cortical prehabilitation relating to perisylvian cortex, though it remains an under-explored investigational tool. Preliminary findings may prove sufficient for the continued investigation of prehabilitation in small-volume lower-grade tumour or epilepsy patients. However, considering the very low number of peer-reviewed case reports, optimal stimulation parameters and duration of therapy necessary to catalyse functional reorganisation remain equivocal. The non-invasive nature and low risk profile of rTMS-NICP may permit larger sample sizes and control groups until such time that eDCS-NICP protocols can be further elucidated.
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