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Lespérance P, Desbeaumes Jodoin V, Drouin D, Racicot F, Miron JP, Longpré-Poirier C, Fournier-Gosselin MP, Thebault P, Lapointe R, Arbour N, Cailhier JF. Vagus Nerve Stimulation Modulates Inflammation in Treatment-Resistant Depression Patients: A Pilot Study. Int J Mol Sci 2024; 25:2679. [PMID: 38473935 DOI: 10.3390/ijms25052679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Vagal neurostimulation (VNS) is used for the treatment of epilepsy and major medical-refractory depression. VNS has neuropsychiatric functions and systemic anti-inflammatory activity. The objective of this study is to measure the clinical efficacy and impact of VNS modulation in depressive patients. Six patients with refractory depression were enrolled. Depression symptoms were assessed with the Montgomery-Asberg Depression Rating, and anxiety symptoms with the Hamilton Anxiety Rating Scale. Plasmas were harvested prospectively before the implantation of VNS (baseline) and up to 4 years or more after continuous therapy. Forty soluble molecules were measured in the plasma by multiplex assays. Following VNS, the reduction in the mean depression severity score was 59.9% and the response rate was 87%. Anxiety levels were also greatly reduced. IL-7, CXCL8, CCL2, CCL13, CCL17, CCL22, Flt-1 and VEGFc levels were significantly lowered, whereas bFGF levels were increased (p values ranging from 0.004 to 0.02). This exploratory study is the first to focus on the long-term efficacy of VNS and its consequences on inflammatory biomarkers. VNS may modulate inflammation via an increase in blood-brain barrier integrity and a reduction in inflammatory cell recruitment. This opens the door to new pathways involved in the treatment of refractory depression.
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Affiliation(s)
- Paul Lespérance
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC H2X 0C1, Canada
| | - Véronique Desbeaumes Jodoin
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC H2X 0C1, Canada
| | - David Drouin
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Frédéric Racicot
- Division of Neurosurgery, CHUM, Université de Montréal, Montreal, QC H2X 0C1, Canada
| | - Jean-Philippe Miron
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC H2X 0C1, Canada
| | - Christophe Longpré-Poirier
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC H2X 0C1, Canada
| | | | - Paméla Thebault
- Centre de Recherche du CHUM (CRCHUM), Institut du Cancer de Montréal, Montreal, QC H2X 0A9, Canada
| | - Réjean Lapointe
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Centre de Recherche du CHUM (CRCHUM), Institut du Cancer de Montréal, Montreal, QC H2X 0A9, Canada
| | - Nathalie Arbour
- Department of Neurosciences, Université de Montréal and CRCHUM, Montreal, QC H2X 0A9, Canada
| | - Jean-François Cailhier
- Department of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Centre de Recherche du CHUM (CRCHUM), Institut du Cancer de Montréal, Montreal, QC H2X 0A9, Canada
- Department of Medicine, Renal Division, CHUM, Université de Montréal, Montreal, QC H2X 0C1, Canada
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Massé-Leblanc C, Desbeaumes Jodoin V, Nguyen DK, Fournier-Gosselin MP, Stip E, Lespérance P, Miron JP. Evaluating real-world effectiveness of accelerated transcranial magnetic stimulation for treatment-resistant depression in a tertiary referral center based in Quebec, Canada. Psychiatry Res 2024; 332:115685. [PMID: 38154411 DOI: 10.1016/j.psychres.2023.115685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To assess the effectiveness of accelerated transcranial magnetic stimulation (TMS) for treatment-resistant depression (TRD) in a tertiary referral center in Quebec, Canada, focusing on a real-world clinical setting. METHODS We reviewed the data of 247 TRD patients treated between January 2012 and May 2022 who received accelerated TMS. Participants were adults diagnosed with unipolar or bipolar depression, resistant to at least two antidepressant trials, and assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS Significant symptom reduction was found in the completer sample (N = 147), with 46.3 % of patients meeting post-treatment response criteria and 36.1 % achieving remission. Baseline severity of depression, age, and the number of antidepressant trials were key predictors of treatment outcomes. Patients who did not complete treatment had generally more severe depressive and anxious symptoms and greater treatment resistance. No significant differences in response rates were observed across different TMS coils. CONCLUSION The study demonstrated the effectiveness and tolerability of accelerated TMS for TRD in a real-world clinical setting.
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Affiliation(s)
- Camille Massé-Leblanc
- Département de Neurosciences, Faculté of Médecine, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Dang Khoa Nguyen
- Département de Neurosciences, Faculté of Médecine, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Fournier-Gosselin
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de chirurgie et de neurochirurgie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
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Miron JP, Couture M, Desbeaumes Jodoin V, Bousseau E, Massé-Leblanc C, Bolduc C, Blumberger DM, Datta A, Nitsche MA, Lespérance P. Contact dermatitis following an intensive transcranial direct current stimulation protocol for major depressive disorder. Brain Stimul 2023; 16:1273-1275. [PMID: 37619893 DOI: 10.1016/j.brs.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023] Open
Affiliation(s)
- Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
| | - Maxime Couture
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Emma Bousseau
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Camille Massé-Leblanc
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Chantal Bolduc
- Département de Médecine, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Abhishek Datta
- Research and Development, Soterix Medical, Woodbridge, NJ, USA; City College of New York, New York, NY, USA
| | - Michael A Nitsche
- IfADo Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund, Germany & Bielefeld University, University Hospital OWL, Protestant Hospital of Bethel Foundation, University Clinic of Psychiatry and Psychotherapy, University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Germany
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
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Payette O, Lespérance P, Jodoin VD, Longpré-Poirier C, Elkrief L, Richard M, Garel N, Miron JP. Intravenous ketamine for treatment-resistant depression patients who have failed to respond to transcranial magnetic stimulation: A case series. J Affect Disord 2023; 333:18-20. [PMID: 37075822 DOI: 10.1016/j.jad.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/18/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND For individuals with treatment-resistant depression (TRD), transcranial magnetic stimulation (TMS) has become a well-established approach. In the past decade, intravenous (IV) racemic ketamine has also emerged as a potential treatment for TRD. Currently, little data is available on the clinical effects of IV racemic ketamine in TRD patients who experienced TMS-failure. METHODS Twenty-one (21) TRD patients who had failed to respond to a standard course of high-frequency left-dorsolateral prefrontal cortex TMS were subsequently scheduled to received IV racemic ketamine infusions. The IV racemic ketamine protocol consisted of 0,5 mg/kg infusions over 60 min, 3 times a week over 2 weeks. RESULTS Treatment was safe with minimal side-effects. Mean baseline MADRS score was 27.6 ± 6.4 (moderate depression), decreasing down to 18.6 ± 8.9 (mild depression) post-treatment. Mean percent improvement was 34.5 % ± 21.1 from baseline to post-treatment. Paired sample t-test showed significant MADRS score decrease pre- to post-treatment [t(20) = 7.212, p < .001]. Overall, four (4) patients (19.0 %) responded and two (2) of those achieved remission (9.5 %). LIMITATIONS Limitations of this case series include its retrospective and uncontrolled open-label nature, the lack of self-rating and standardized adverse events questionnaires, as well as follow-ups beyond the immediate treatment period. CONCLUSIONS Novel ways to increase the clinical effects of ketamine are being explored. We discuss potential combination approaches of ketamine with other modalities to augment its effects. Given the global burden of TRD, novel approaches are needed to curb the current mental health epidemic around the world.
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Affiliation(s)
- Olivier Payette
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | | | - Laurent Elkrief
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Maxime Richard
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Nicolas Garel
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
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Payette O, Jodoin VD, Medjahed N, Massé-Leblanc C, Elkrief L, Longpré-Poirier C, Lespérance P, Miron JP. Intravenous ketamine for treatment-resistant depression in patients who have failed to respond to transcranial magnetic stimulation: a case series. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Sheen JZ, Miron JP, Mansouri F, Dunlop K, Russell T, Zhou R, Hyde M, Fox L, Voetterl H, Daskalakis ZJ, Griffiths JD, Blumberger DM, Downar J. Cardiovascular biomarkers of response to accelerated low frequency repetitive transcranial magnetic stimulation in major depression. J Affect Disord 2022; 318:167-174. [PMID: 36055538 DOI: 10.1016/j.jad.2022.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 07/04/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is an effective and safe treatment for major depressive disorder (MDD). rTMS is in need of a reliable biomarker of treatment response. High frequency (HF) dorsolateral prefrontal cortex (DLPFC) rTMS has been reported to induce significant changes in the cardiac activity of MDD patients. Low frequency DLPFC rTMS has many advantages over HF-DLPFC rTMS and thus this study aims to further investigate the effect of low frequency 1 Hz right hemisphere (R)-DLPFC rTMS on the cardiac activity of MDD patients, as well as the potential of using electrocardiogram (ECG) parameters as biomarkers of treatment outcome. METHODS Baseline ECG sessions were performed for 19 MDD patients. All patients then underwent 40 sessions of accelerated 1 Hz R-DLPFC rTMS one week after the baseline session. RESULTS Heart rate (HR) significantly decreased from the resting period to the first and third minute of the 1 Hz R-DLPFC rTMS period. Resting HR was found to have a significant negative association with treatment outcome. Prior to Bonferroni correction, HR during stimulation and the degree of rTMS-induced HR reduction were significantly negatively associated with treatment outcome. No significant changes were observed for the heart rate variability (HRV) parameters. LIMITATIONS Sample size (n = 19); the use of electroencephalography equipment for ECG; lack of respiration monitoring; relatively short recording duration for HRV parameters. CONCLUSION This novel study provides further preliminary evidence that ECG may be utilized as a biomarker of rTMS treatment response in MDD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04376697.
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Affiliation(s)
- Jack Z Sheen
- Institute of Medical Science, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada
| | - Jean-Philippe Miron
- Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Canada; Département de Psychiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Farrokh Mansouri
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Katharine Dunlop
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada; Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Unity Health Toronto, USA; Centre for Depression and Suicide Studies, St. Michael's Hospital, Unity Health Toronto, USA
| | - Thomas Russell
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Ryan Zhou
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Molly Hyde
- Institute of Medical Science, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada
| | - Linsay Fox
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Helena Voetterl
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada; Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - John D Griffiths
- Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada; Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada
| | - Jonathan Downar
- Institute of Medical Science, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada.
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Garel N, McAnulty C, Greenway KT, Lesperance P, Miron JP, Rej S, Richard-Devantoy S, Jutras-Aswad D. Efficacy of ketamine intervention to decrease alcohol use, cravings, and withdrawal symptoms in adults with problematic alcohol use or alcohol use disorder: A systematic review and comprehensive analysis of mechanism of actions. Drug Alcohol Depend 2022; 239:109606. [PMID: 36087563 DOI: 10.1016/j.drugalcdep.2022.109606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alcohol use disorder is highly prevalent and has important economical, societal, psychiatric, and medical consequences. All currently approved therapeutic approaches targeting alcohol dependence have relatively modest effects and high relapse rates. Recent evidence suggests that ketamine may be an effective intervention to treat alcohol use disorder and alcoholic withdrawal. This systematic review aimed to assess the current level of evidence for this intervention. METHODS This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the international database of systematic reviews PROSPERO. Medline(Ovid), CINAHL Complete(EBSCOhost), PsycINFO(Ovid), EBM Reviews(Ovid), EMBASE(Ovid), and Google Scholar were searched for studies using ketamine to treat harmful alcohol use, craving, or withdrawal states in humans. Studies of any methodology that evaluated ketamine in isolation or combination with other interventions were included. The risk of bias was assessed using specific Cochrane critical appraisal tools. RESULTS Of 1922 abstracts identified, 8 full-text articles were eligible for inclusion, yielding a total sample size of 634 participants. Five studies investigated the impact of ketamine on alcohol use and/or cravings and/or withdrawal in outpatient settings. Three studies looked at the effect of adding ketamine to conventional treatment of withdrawal symptoms in participants admitted to intensive care unit for severe alcohol withdrawal. Results on primary outcomes were mixed within and across trials. CONCLUSIONS Despite promising results, the current evidence does not permit definitive conclusions about the efficacy of ketamine in alcohol use disorders or withdrawal. Future studies are warranted.
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Affiliation(s)
- Nicolas Garel
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Christina McAnulty
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Kyle T Greenway
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada
| | - Paul Lesperance
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Jean-Philippe Miron
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada
| | - Soham Rej
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada; McGill Meditation and Mind-Body Medicine Research Clinic and Geri-PARTy Research Group, Lady Davis Research Institute and Jewish General Hospital, Montreal, Quebec H3T 1E2, Canada
| | - Stephane Richard-Devantoy
- Department of Psychiatry, Faculty of Medecine, McGill University, Ludmer Research & Training Building, 1033 Av. des Pins, Montréal, Quebec H3A 1A1, Canada; Douglas Mental Health Research Institute, McGill Group for Suicide Studies, 6875 Boulevard LaSalle, Montréal, Québec H4H 1R3, Canada
| | - Didier Jutras-Aswad
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T1J4, Canada.
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Richard M, Noiseux C, Desbeaumes Jodoin V, Blumberger DM, Sheen J, Mansouri F, Elkrief L, Longpré-Poirier C, Lespérance P, Miron JP. Prolonged intermittent theta burst stimulation in the treatment of major depressive disorder: a case series. Psychiatry Res 2022; 315:114709. [PMID: 35816923 DOI: 10.1016/j.psychres.2022.114709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022]
Abstract
Intermittent theta burst stimulation (iTBS) using 600 pulses is an effective and FDA-cleared transcranial magnetic stimulation (TMS) protocol for major depressive disorder (MDD). Prolonged iTBS (piTBS) using 1,800 pulses could increase the effectiveness of TMS for MDD, but its real-world effectiveness is still debated. We assessed the safety, tolerability, and preliminary effectiveness of a 3x daily piTBS 1,800 pulses protocol delivered over 2 weeks in 27 participants. Only four participants (18.2%) achieved response, two of them achieving remission (9.1%). Five participants (18.5%) experienced tolerability issues. Future studies should focus on the neurophysiological effects of TBS protocols to determine optimal parameters.
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Affiliation(s)
- Maxime Richard
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
| | - Clémence Noiseux
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Jack Sheen
- Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada
| | - Farrokh Mansouri
- Institute of Medical Science, Faculty of Medicine, University of Toronto, ON, Canada
| | - Laurent Elkrief
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Christophe Longpré-Poirier
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM) et Centre de Recherche du CHUM (CRCHUM), Université de Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, QC, Canada.
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Longpré-Poirier C, Juster RP, Miron JP, Kerr P, Cipriani E, Desbeaumes Jodoin V, Lespérance P. Allostatic load as a predictor of response to repetitive transcranial magnetic stimulation in treatment resistant depression: Research protocol and hypotheses. Comprehensive Psychoneuroendocrinology 2022; 10:100133. [PMID: 35755203 PMCID: PMC9216427 DOI: 10.1016/j.cpnec.2022.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Christophe Longpré-Poirier
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
- Corresponding author. CHUM, Department of Psychiatry, 1051 rue Sanguinet, Montréal, Québec, H2X 0C1, Canada.
| | - Robert-Paul Juster
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Jean-Philippe Miron
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Kerr
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Enzo Cipriani
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l’Institut universitaire en santé mentale (CR-IUSMM), Université de Montréal, Montréal, Québec, Canada
| | - Véronique Desbeaumes Jodoin
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
| | - Paul Lespérance
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, Québec, Canada
- Départment de psychiatrie et d'addictologie, Université de Montréal, Montréal, Québec, Canada
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10
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Elkrief L, Payette O, Foucault JN, Longpré-Poirier C, Richard M, Desbeaumes Jodoin V, Lespérance P, Miron JP. Transcranial magnetic stimulation and intravenous ketamine combination therapy for treatment-resistant bipolar depression: A case report. Front Psychiatry 2022; 13:986378. [PMID: 36213934 PMCID: PMC9532540 DOI: 10.3389/fpsyt.2022.986378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/23/2022] [Indexed: 11/20/2022] Open
Abstract
About a third of patients suffering from major depression develop treatment-resistant depression (TRD). Although repetitive transcranial magnetic stimulation (rTMS) and intravenous ketamine have proven effective for the management of TRD, many patients remain refractory to treatment. We present the case of a patient suffering from bipolar TRD. The patient was referred to us after failure to respond to first-and second-line pharmacotherapy and psychotherapy. After minimal response to both rTMS and ketamine alone, we attempted a combination rTMS and ketamine protocol, which led to complete and sustained remission. Various comparable and complimentary mechanisms of antidepressant action of ketamine and rTMS are discussed, which support further study of this combination therapy. Future research should focus on the feasibility, tolerability, and efficacy of this novel approach.
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Affiliation(s)
- Laurent Elkrief
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Olivier Payette
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Jean-Nicolas Foucault
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Christophe Longpré-Poirier
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Maxime Richard
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal et Centre de Recherche du CHUM, Université de Montréal, Montreal, QC, Canada.,Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montreal, QC, Canada
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11
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Miron JP, Sheen J, Panzarella T, Hyde M, Mansouri F, Fox L, Voetterl H, Desbeaumes Jodoin V, Lespérance P, Longpré-Poirier C, Juster RP, Daskalakis ZJ, Blumberger DM, Downar J. The relationship between pre-treatment heart rate variability and response to low-frequency accelerated repetitive transcranial magnetic stimulation in major depression. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Voetterl H, Miron JP, Mansouri F, Fox L, Hyde M, Blumberger DM, Daskalakis ZJ, Vila-Rodriguez F, Sack AT, Downar J. Investigating EEG biomarkers of clinical response to low frequency rTMS in depression. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Noiseux C, Jodoin VD, Lespérance P, Chouinard S, Miron JP. Repetitive transcranial magnetic stimulation for major depressive disorder comorbid with huntington’s disease: a case report. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Noiseux C, Jodoin VD, Blumberger D, Lespérance P, Miron JP. Prolonged intermittent theta burst stimulation in the treatment of major depressive disorder. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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15
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Miron JP, Jodoin VD, Lespérance P, Blumberger D. Heart rate variability as a predictive biomarker to accelerated repetitive transcranial magnetic stimulation in major depression. Brain Stimul 2021. [DOI: 10.1016/j.brs.2021.10.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Miron JP, Voetterl H, Fox L, Hyde M, Mansouri F, Dees S, Zhou R, Sheen J, Desbeaumes Jodoin V, Mir-Moghtadaei A, Blumberger DM, Daskalakis ZJ, Vila-Rodriguez F, Downar J. Optimized repetitive transcranial magnetic stimulation techniques for the treatment of major depression: A proof of concept study. Psychiatry Res 2021; 298:113790. [PMID: 33581379 DOI: 10.1016/j.psychres.2021.113790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/03/2021] [Indexed: 01/29/2023]
Abstract
Although effective in major depressive disorder (MDD), repetitive transcranial magnetic stimulation (rTMS) is costly and complex, limiting accessibility. To address this, we tested the feasibility of novel rTMS techniques with cost-saving opportunities, such as an open-room setting, large non-focal parabolic coils, and custom-built coil arms. We employed a low-frequency (LF) 1 Hz stimulation protocol (360 pulses per session), delivered on the most affordable FDA-approved device. MDD participants received an initial accelerated rTMS course (arTMS) of 6 sessions/day over 5 days (30 total), followed by a tapering course of daily sessions (up to 25) to decrease the odds of relapse. The self-reported Beck Depression Inventory II (BDI-II) was used to measure severity of depression. Forty-eight (48) patients completed the arTMS course. No serious adverse events occurred, and all patients reported manageable pain levels. Response and remission rates were 35.4% and 27.1% on the BDI-II, respectively, at the end of the tapering course. Repeated measures ANOVA showed significant changes of BDI-II scores over time. Even though our protocol will require further improvements, some of the concepts we introduced here could help guide the design of future trials aiming at increasing accessibility to rTMS.
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Affiliation(s)
- Jean-Philippe Miron
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM) et Département de Psychiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
| | - Helena Voetterl
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Department of Cognitive Neuroscience, Maastricht University, Maastricht, Limburg, Netherland
| | - Linsay Fox
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Molly Hyde
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Farrokh Mansouri
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sinjin Dees
- Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Ryan Zhou
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Jack Sheen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM) et Département de Psychiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Arsalan Mir-Moghtadaei
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, San Diego, California, United States
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Downar
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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17
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Miron JP, Hyde M, Fox L, Sheen J, Voetterl H, Mansouri F, Desbeaumes Jodoin V, Zhou R, Dees S, Mir-Moghtadaei A, Blumberger DM, Daskalakis ZJ, Vila-Rodriguez F, Downar J. Evaluation of a 5 day accelerated 1 Hz repetitive transcranial magnetic stimulation protocol in major depression: A feasibility study. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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18
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Longpré-Poirier C, Miron JP, Desbeaumes Jodoin V, Fournier-Gosselin MP, Lespérance P. Vagus Nerve Stimulation for Treatment-Resistant Depression: a Case Series of Clinical Symptoms Associated with the End of Service Period. J Affect Disord 2021; 281:646-648. [PMID: 33223232 DOI: 10.1016/j.jad.2020.11.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/02/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This work describes the clinical symptoms associated with end of service (EOS) of the batteries of vagus nerve stimulation (VNS) generators in treatment-resistant depression (TRD). Because neurostimulator software may not provide reliable information on battery depletion, careful monitoring of clinical symptoms during the EOS period is an important concern in the follow-up of TRD patients treated with VNS therapy. METHODS Twenty-six (26) patients were implanted and followed at the Centre Hospitalier de l'Université de Montréal. Fourteen (14) patients required battery replacement and we retrieved chart data up to 3 months before generator battery replacement. RESULTS Our study demonstrated there might be a decrease or increase in VNS associated physical side effects, and possibly an increase in depressive symptoms during EOS. LIMITATIONS Our observations are limited by the retrospective nature of this small case series, and larger prospective studies evaluating both VNS side effects and depressive symptoms are therefore needed to further validate those findings. CONCLUSION Our study is the first to examine clinical symptoms associated with EOS of the batteries of VNS in TRD.
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Affiliation(s)
- Christophe Longpré-Poirier
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de psychiatrie du CHUM, Université de Montréal, Montréal, QC, Canada.
| | - Jean-Philippe Miron
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de psychiatrie du CHUM, Université de Montréal, Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de psychiatrie du CHUM, Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Fournier-Gosselin
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Département de chirurgie et de neurochirurgie du CHUM, Université de Montréal, Montréal, QC, Canada
| | - Paul Lespérance
- Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada; Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de psychiatrie du CHUM, Université de Montréal, Montréal, QC, Canada
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19
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Miron JP, Jodoin VD, Lespérance P, Blumberger DM. Repetitive transcranial magnetic stimulation for major depressive disorder: basic principles and future directions. Ther Adv Psychopharmacol 2021; 11:20451253211042696. [PMID: 34589203 PMCID: PMC8474312 DOI: 10.1177/20451253211042696] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a safe and well-tolerated intervention for major depressive disorder (MDD). Over 150 randomized controlled trials (RCTs) have been carried out, and its efficacy has been confirmed in dozens of meta-analyses. Real world data has also confirmed the effectiveness of rTMS for MDD in clinical practice, with the most recent literature indicating response rates of 40-50% and remission rates of 25-30%. In this review, we first offer an historical perspective, followed by a review of basic principles, such as putative mechanisms, procedures and protocols, stimulation targets, efficacy and durability of response, side effects, and the placebo controversy. In the second part of this review, we first discuss solutions to increase accessibility to rTMS, such as modifications to treatment equipment, protocols and setting. We continue with possible means to further increase effectiveness, such as treatment personalization and extension. We conclude by addressing the scheduling issue, with accelerated rTMS (arTMS) as a possible solution.
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Affiliation(s)
- Jean-Philippe Miron
- Centre de Recherche du CHUM (CRCHUM), Centre Hospitalier de l'Université de Montréal (CHUM) and Département de Psychiatrie, Faculté de Médecine, Université́ de Montréal, Montréal, QC, Canada Institute of Medical Science and Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada CHUM, 1051 Sanguinet, Montréal, QC, H2X 3E4, Canada
| | - Véronique Desbeaumes Jodoin
- CRCHUM, CHUM and Département de Psychiatrie, Faculté de Médecine, Université́ de Montréal, Montréal, QC, Canada
| | - Paul Lespérance
- CRCHUM, CHUM and Département de Psychiatrie, Faculté de Médecine, Université́ de Montréal, Montréal, QC, Canada
| | - Daniel M Blumberger
- Institute of Medical Science and Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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20
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Longpré-Poirier C, Desbeaumes Jodoin V, Miron JP, Lespérance P. "Remote Monitoring of Intranasal Ketamine Self-Administration as Maintenance Therapy in Treatment-Resistant Depression (TRD): A Novel Strategy for Vulnerable and At-Risk Populations to COVID-19?". Am J Geriatr Psychiatry 2020; 28:892-893. [PMID: 32446640 PMCID: PMC7198393 DOI: 10.1016/j.jagp.2020.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Christophe Longpré-Poirier
- Unité de Neuromodulation Psychiatrique (UNP) (CLP, VDJ, JPM, and PL), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada; Centre de Recherche du CHUM (CRCHUM) (CLP, VDJ, JPM, and PL), Université de Montréal, Montréal, QC, Canada; Départment de psychiatrie du CHUM (CLP, VDJ, JPM, and PL), Université de Montréal, Montréal, QC, Canada.
| | - Véronique Desbeaumes Jodoin
- Unité de Neuromodulation Psychiatrique (UNP) (CLP, VDJ, JPM, and PL), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada,Centre de Recherche du CHUM (CRCHUM) (CLP, VDJ, JPM, and PL), Université de Montréal, Montréal, QC, Canada,Départment de psychiatrie du CHUM (CLP, VDJ, JPM, and PL), Université de Montréal, Montréal, QC, Canada
| | - Jean-Philippe Miron
- Unité de Neuromodulation Psychiatrique (UNP) (CLP, VDJ, JPM, and PL), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada,Centre de Recherche du CHUM (CRCHUM) (CLP, VDJ, JPM, and PL), Université de Montréal, Montréal, QC, Canada,Départment de psychiatrie du CHUM (CLP, VDJ, JPM, and PL), Université de Montréal, Montréal, QC, Canada
| | - Paul Lespérance
- Unité de Neuromodulation Psychiatrique (UNP) (CLP, VDJ, JPM, and PL), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada,Centre de Recherche du CHUM (CRCHUM) (CLP, VDJ, JPM, and PL), Université de Montréal, Montréal, QC, Canada,Départment de psychiatrie du CHUM (CLP, VDJ, JPM, and PL), Université de Montréal, Montréal, QC, Canada
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21
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Miron JP, Sheen J, Mansouri F, Blumberger DM, Daskalakis ZJ, Vila-Rodriguez F, Downar J. The role of low-frequency repetitive transcranial magnetic stimulation in major depression: A call to increase the evidence base. Brain Stimul 2020; 13:1296-1297. [PMID: 32580026 PMCID: PMC7306196 DOI: 10.1016/j.brs.2020.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jean-Philippe Miron
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Unité de Neuromodulation Psychiatrique, Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada.
| | - Jack Sheen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Farrokh Mansouri
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Downar
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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22
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Doré-Gauthier V, Miron JP, Jutras-Aswad D, Ouellet-Plamondon C, Abdel-Baki A. Specialized assertive community treatment intervention for homeless youth with first episode psychosis and substance use disorder: A 2-year follow-up study. Early Interv Psychiatry 2020; 14:203-210. [PMID: 31274239 DOI: 10.1111/eip.12846] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/19/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022]
Abstract
AIM No previous study has investigated interventions for homeless youth suffering from first episode psychosis and comorbid substance use disorder (HYPS). An intensive assertive community intervention team (IACIT) offering outreach interventions, housing support as well as integrated care for early psychosis and substance use disorder (SUD) was created in 2012 at the Centre Hospitalier de l'Université de Montréal (CHUM). To explore the impact of the addition of an IACIT to an early intervention for psychosis service (EIS) on housing stability, functional and symptomatic outcomes and mental health service use. METHODS A two-year longitudinal study comparing the outcome of HYPS receiving combined EIS and IACIT since 2012, to a historical cohort of HYPS receiving EIS only between 2005 and 2011. Socio-demographic data, housing stability, functioning, illness severity, SUD severity, emergency room visits and hospitalizations were assessed at admission, at 1 month, and every 3 months thereafter. RESULTS HYPS receiving EIS + IACIT achieved housing stability more rapidly and spent less time hospitalized than HYPS getting EIS only (RR 2.38, P = .017). HYPS with cocaine misuse were less likely to attain housing stability (RR 0.25, P = .04). No between-group differences were found for psychiatric symptoms, functioning and SUD outcomes. CONCLUSION The addition of IACIT-HYPS to EIS was associated with earlier housing stability and reduced total hospitalization days compared to EIS alone.
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Affiliation(s)
| | - Jean-Philippe Miron
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry, CHUM, Université de Montréal, Montréal, Quebec, Canada.,CRCHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Dider Jutras-Aswad
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry, CHUM, Université de Montréal, Montréal, Quebec, Canada.,CRCHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry, CHUM, Université de Montréal, Montréal, Quebec, Canada.,CRCHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada.,Department of Psychiatry, CHUM, Université de Montréal, Montréal, Quebec, Canada.,CRCHUM, Université de Montréal, Montréal, Quebec, Canada
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Miron JP, Voetterl H, Mansouri F, Blumberger DM, Daskalakis ZJ, Downar J. A case series of a novel 1 Hz right-sided dorsolateral prefrontal cortex rTMS protocol in major depression. Brain Stimul 2020; 13:372-374. [DOI: 10.1016/j.brs.2019.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 10/30/2019] [Accepted: 11/06/2019] [Indexed: 11/26/2022] Open
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Marafon SB, Miron JP, Juncal VR, Figueiredo N, Downar J, Blumberger DM, Daskalakis ZJ, Muni RH. Retinal tear and posterior vitreous detachment following repetitive transcranial magnetic stimulation for major depression: A case report. Brain Stimul 2019; 13:467-469. [PMID: 31884185 DOI: 10.1016/j.brs.2019.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Samara B Marafon
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Jean-Philippe Miron
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada
| | - Verena R Juncal
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Natalia Figueiredo
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Poul Hansen Family Centre for Depression, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rajeev H Muni
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, ON, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada; Kensington Vision and Research Centre, Toronto, ON, Canada.
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Miron JP, Feffer K, Cash RFH, Derakhshan D, Kim JMS, Fettes P, Giacobbe P, Blumberger DM, Daskalakis ZJ, Downar J. Safety, tolerability and effectiveness of a novel 20 Hz rTMS protocol targeting dorsomedial prefrontal cortex in major depression: An open-label case series. Brain Stimul 2019; 12:1319-1321. [PMID: 31266722 DOI: 10.1016/j.brs.2019.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jean-Philippe Miron
- MRI-Guided rTMS Clinic and Krembil Research Institute, University Health Network, Toronto, Canada; Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Unité de Neuromodulation Psychiatrique (UNP), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Canada.
| | - Kfir Feffer
- Lev-Hasharon Mental Health Center, Tzur-Moshe and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Robin F H Cash
- Departments of Psychiatry and Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Dorsa Derakhshan
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Min Seok Kim
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Fettes
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Daniel M Blumberger
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jonathan Downar
- MRI-Guided rTMS Clinic and Krembil Research Institute, University Health Network, Toronto, Canada; Department of Psychiatry and Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Desbeaumes Jodoin V, Miron JP, Lespérance P. Safety and Efficacy of Accelerated Repetitive Transcranial Magnetic Stimulation Protocol in Elderly Depressed Unipolar and Bipolar Patients. Am J Geriatr Psychiatry 2019; 27:548-558. [PMID: 30527274 DOI: 10.1016/j.jagp.2018.10.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Major depressive disorder (MDD) is a prevalent condition in older adults. Although antidepressant drugs are commonly prescribed, efficacy is variable, and older patients are more prone to side effects. Repetitive transcranial magnetic stimulation (rTMS) is an alternative therapy used increasingly in the treatment of MDD. Even though recent studies have shown efficacy of rTMS in elderly depressed patients, the safety and efficacy of accelerated rTMS has not been studied in this population. METHODS Data were retrospectively analyzed for adults with treatment-resistant depression (N = 73, n = 19 ≥60years, n = 54 <60 years) who underwent an accelerated protocol of 30 sessions (2 sessions per day) of left dorsolateral prefrontal cortex high-frequency (20 Hz) rTMS. RESULTS There were statistically significant improvements in depression and anxiety symptoms from baseline to post-treatment in both age groups, but those 60years and older showed statistically greater improvement in depression and anxiety symptom scores (p = 0.01) than those less than 60. There were significantly more responders (p = 0.001) and remitters (p = 0.023) in the older group. The age groups did not differ significantly in clinical and demographic characteristics or severity of current depressive episode, although baseline anxiety was less severe in those 60years and older. Unipolar and bipolar patients had a similar clinical response, and treatment appeared to be well tolerated by all patients. CONCLUSION Our results suggest that accelerated rTMS protocol is a safe and effective treatment for unipolar and bipolar depressed subjects, including older adults.
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Affiliation(s)
| | - Jean-Philippe Miron
- Department of Psychiatry (VDJ, JPM, PL), Centre Hospitalier de l'Université de Montréal, Montréal
| | - Paul Lespérance
- Department of Psychiatry (VDJ, JPM, PL), Centre Hospitalier de l'Université de Montréal, Montréal.
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Miron JP, Desbeaumes Jodoin V, Montplaisir L, Lespérance P. Significant differences in motor threshold between figure-8 and double-cone coils for repetitive transcranial magnetic stimulation in patients with refractory depression. The European Journal of Psychiatry 2018. [DOI: 10.1016/j.ejpsy.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Miron JP, Abdel-Baki A. Cognitive-behavioural therapy can prevent transition to psychosis in ultra-high-risk participants in the long term. Evid Based Ment Health 2017; 20:e10. [PMID: 28389431 PMCID: PMC10688531 DOI: 10.1136/eb-2016-102569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/28/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Jean-Philippe Miron
- Université de Montréal, Centre Hospitalier de l'Université de Montréal and Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Amal Abdel-Baki
- Université de Montréal, Centre Hospitalier de l'Université de Montréal and Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Dyson KS, Miron JP, Drew T. Differential modulation of descending signals from the reticulospinal system during reaching and locomotion. J Neurophysiol 2014; 112:2505-28. [PMID: 25143539 DOI: 10.1152/jn.00188.2014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We tested the hypothesis that the same spinal interneuronal pathways are activated by the reticulospinal system during locomotion and reaching. If such were the case, we expected that microstimulation within the pontomedullary reticular formation (PMRF) would evoke qualitatively similar responses in muscles active during both behaviors. To test this, we stimulated in 47 sites within the PMRF during both tasks. Stimulation during locomotion always produced a strongly phase-dependent, bilateral pattern of activity in which activity in muscles was generally facilitated or suppressed during one phase of activity (swing or stance) and was unaffected in the other. During reaching, stimulation generally activated the same muscles as during locomotion, although the modulation of the magnitude of the evoked responses was less limb dependent than during locomotion. An exception was found for some forelimb flexor muscles that were strongly facilitated by stimulation during the swing phase of locomotion but were not influenced by stimulation during the transport phase of the reach. We suggest that during locomotion the activity in interneuronal pathways mediating signals from the reticulospinal system is subject to strong modulation by the central pattern generator for locomotion. During reach, we suggest that, for most muscles, the same spinal interneuronal pathways are used to modify muscle activity but are not as strongly gated according to limb use as during locomotion. Finally, we propose that the command for movement during discrete voluntary movements suppresses the influence of the reticulospinal system on selected forelimb flexor muscles, possibly to enhance fractionated control of movement.
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Affiliation(s)
- Kenneth S Dyson
- Département de Neurosciences, Université de Montréal, Montreal, Quebec, Canada; and Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Philippe Miron
- Département de Neurosciences, Université de Montréal, Montreal, Quebec, Canada; and
| | - Trevor Drew
- Département de Neurosciences, Université de Montréal, Montreal, Quebec, Canada; and Groupe de recherche sur le système nerveux central (GRSNC), Université de Montréal, Montreal, Quebec, Canada
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Miron JP, Cuckle H, Miron P. Prenasal thickness in first-trimester screening for Down syndrome. Prenat Diagn 2012; 32:695-7. [PMID: 22544612 DOI: 10.1002/pd.3879] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/02/2012] [Indexed: 11/10/2022]
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