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Bouaziz N, Laidi C, Bulteau S, Berjamin C, Thomas F, Moulier V, Benadhira R, Szekely D, Poulet E, Galvao F, Guillin O, Castillo MC, Sauvaget A, Plaze M, Januel D, Brunelin J, Rotharmel M. Real world transcranial magnetic stimulation for major depression: A multisite, naturalistic, retrospective study. J Affect Disord 2023; 326:26-35. [PMID: 36708953 DOI: 10.1016/j.jad.2023.01.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND In 2008, the U.S. FDA approved rTMS as a treatment against medication-resistant depression. However, real-world rTMS outcomes remain understudied. This study investigates how rTMS for depression is delivered in routine clinical practice in France, and measures its effectiveness as well as its moderators. METHODS Five centers provided retrospective data on patients who were treated with rTMS for treatment-resistant depression from January 2015 to December 2020. Patients were assessed twice using a hetero-questionnaire, with baseline and immediate post-treatment assessments. We conducted univariate analyses to study which factors were significantly associated with rTMS effectiveness. We then included age, gender, and significant factors in a multivariate model. RESULTS We collected data from 435 patients with a mean age of 51.27 (14.91): 66 % were female, and 26 % suffered from bipolar depression. Stimulation was delivered using four different stimulation parameters: 1 Hz (7 % of the individuals), 10 Hz (43 %), 20 Hz (12 %), and 50 Hz (intermittent Theta Burst Stimulation, iTBS) (38 %). The mean improvement of depressive symptoms was 33 % (p < 0.001, effect-size: 0.79). Response and remission rates were of 31 % and 22.8 %, respectively. In the multivariate analysis, improvement in depressive symptoms was associated with higher baseline symptoms. CONCLUSION This is one of the largest studies that investigates, with careful clinician-rated scales by trained psychiatrists, the effect of rTMS in naturalistic settings. Repetitive TMS appears to be effective in routine clinical practice, although its efficacy could be improved by analyzing predictors of response, as well as personalized targeting of specific brain areas.
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Affiliation(s)
- Noomane Bouaziz
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; La Fondation FondaMental, F-94010 Créteil, France.
| | - Charles Laidi
- La Fondation FondaMental, F-94010 Créteil, France; Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine de Créteil, DMU IMPACT, Hôpitaux Universitaires Mondor, Créteil, France
| | - Samuel Bulteau
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - Caroline Berjamin
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Fanny Thomas
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France
| | - Virginie Moulier
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - René Benadhira
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France
| | | | - Emmanuel Poulet
- Psychiatric emergency service, Hospices Civils de Lyon, F-69005 Lyon, France; Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Filipe Galvao
- Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Olivier Guillin
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | | | - Anne Sauvaget
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - Marion Plaze
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Dominique Januel
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; La Fondation FondaMental, F-94010 Créteil, France; Université Sorbonne Paris Nord. France
| | - Jérôme Brunelin
- Psychiatric emergency service, Hospices Civils de Lyon, F-69005 Lyon, France; Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Maud Rotharmel
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
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Bulteau S, Laurin A, Pere M, Fayet G, Thomas-Ollivier V, Deschamps T, Auffray-Calvier E, Bukowski N, Vanelle JM, Sébille V, Sauvaget A. Intermittent theta burst stimulation (iTBS) versus 10-Hz high-frequency repetitive transcranial magnetic stimulation (rTMS) to alleviate treatment-resistant unipolar depression: A randomized controlled trial (THETA-DEP). Brain Stimul 2022; 15:870-880. [DOI: 10.1016/j.brs.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022] Open
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Wilson S, Croarkin PE, Aaronson ST, Carpenter LL, Cochran M, Stultz DJ, Kozel FA. Systematic review of preservation TMS that includes continuation, maintenance, relapse-prevention, and rescue TMS. J Affect Disord 2022; 296:79-88. [PMID: 34592659 DOI: 10.1016/j.jad.2021.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND A dearth of evidence-based information exists to guide the delivery of transcranial magnetic stimulation (TMS) after a successful acute course of treatment for Major Depressive Disorder. METHODS To provide guidance for clinicians, existing literature focused on "preservation TMS" was systematically reviewed and synthesized. Preservation TMS was defined as TMS used to sustain a clinical response after a successful acute course of treatment and included reports using the terms maintenance, continuation, relapse prevention, or rescue TMS. The review protocol was registered on Open Science Framework and reported following PRISMA guidelines. Data were abstracted by two authors and discrepancies were resolved by a third author. Primary outcome measures focused on clinical efficacy. The evaluated studies were graded using the Levels of Evidence criteria published by the Oxford Centre for Evidence-Based Medicine. RESULTS The search included 536 abstracts and 16 additional papers, from which 63 full articles were screened. Data were abstracted from 30 qualifying sources (N=1,494) including 4 randomized controlled trials (one sham controlled), 14 open trials, and 12 case series. Overall, the quality of existing literature was low regarding efficacy but provided clear support for effectiveness and safety across a range of preservation TMS protocols based on mostly uncontrolled studies. CONCLUSIONS Existing literature suggests that preservation TMS protocols significantly vary and are mostly supported by open trials and case series. Due to a lack of effective alternatives, preservation TMS will likely be required for certain patients who respond to acute TMS therapy. More studies of preservation TMS are critically needed.
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Affiliation(s)
- Saydra Wilson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Scott T Aaronson
- Sheppard Pratt Health System, Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - Linda L Carpenter
- Brown University Department of Psychiatry and Human Behavior, Butler Hospital, Providence, RI, USA
| | - Michelle Cochran
- Department of Psychiatry, Neuroscience and TMS Treatment Centers, Vanderbilt University Medical Center, Brentwood, TN, USA
| | - Debra J Stultz
- Stultz Sleep and Behavioral Health, Barboursville, WV, USA
| | - F Andrew Kozel
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Florida State University, 1115 W. Call Street, Tallahassee, FL 32306, USA.
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Kearney-Ramos T, Haney M. Repetitive transcranial magnetic stimulation as a potential treatment approach for cannabis use disorder. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110290. [PMID: 33677045 PMCID: PMC9165758 DOI: 10.1016/j.pnpbp.2021.110290] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/22/2021] [Accepted: 02/19/2021] [Indexed: 01/22/2023]
Abstract
The expanding legalization of cannabis across the United States is associated with increases in cannabis use, and accordingly, an increase in the number and severity of individuals with cannabis use disorder (CUD). The lack of FDA-approved pharmacotherapies and modest efficacy of psychotherapeutic interventions means that many of those who seek treatment for CUD relapse within the first few months. Consequently, there is a pressing need for innovative, evidence-based treatment development for CUD. Preliminary evidence suggests that repetitive transcranial magnetic stimulation (rTMS) may be a novel, non-invasive therapeutic neuromodulation tool for the treatment of a variety of substance use disorders (SUDs), including recently receiving FDA clearance (August 2020) for use as a smoking cessation aid in tobacco cigarette smokers. However, the potential of rTMS for CUD has not yet been reviewed. This paper provides a primer on therapeutic neuromodulation techniques for SUDs, with a particular focus on reviewing the current status of rTMS research in people who use cannabis. Lastly, future directions are proposed for rTMS treatment development in CUD, with suggestions for study design parameters and clinical endpoints based on current gold-standard practices for therapeutic neuromodulation research.
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Affiliation(s)
- Tonisha Kearney-Ramos
- New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA.
| | - Margaret Haney
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
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