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Zhan D, Gregory EC, Humaira A, Wong H, Klonsky ED, Levit A, Ridgway L, Vila-Rodriguez F. Trajectories of suicidal ideation during rTMS for treatment-resistant depression. J Affect Disord 2024; 360:108-113. [PMID: 38788857 DOI: 10.1016/j.jad.2024.05.109] [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: 12/12/2023] [Revised: 04/29/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND rTMS is a safe and effective intervention for treatment-resistant depression (TRD). However, there is limited data on its specific impact on suicidal ideation (SI), and the trajectory of SI over the treatment course. OBJECTIVE This open-label clinical trial investigated SI outcomes and trajectories in patients with TRD receiving low-frequency rTMS (LFR) to the right dorsolateral prefrontal cortex (DLPFC; N = 55). METHODS A latent class mixed-effect model was used to identify response trajectories for SI as well as core mood symptoms. Logistic regression analyses investigated risk factors associated with identified trajectories. RESULTS For each symptom domain, we identified two distinct trajectories during LFR, one tracking improvement (SI: n = 35, 60 %; mood: n = 29, 53 %) and the other tracking no improvement (SI: n = 20, 40 %; mood: n = 26, 47 %). Male sex, higher baseline anxiety, and higher baseline SI were risk factors for no improvement of SI; while higher baseline anxiety and benzodiazepine use were risk factors for no improvement of mood. Mediation analyses showed that anxiety was a risk factor for no improvement of SI and mood independent of benzodiazepine treatment. CONCLUSIONS This is the first study to investigate trajectories of response to LFR to the right DLPFC. SI and mood improved with LFR in most patients but the severity of anxiety symptoms was a factor of poor prognosis for both. Nuanced characterization of SI response to rTMS may lead to critical insights for individualized targeting strategies.
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Affiliation(s)
- Denghuang Zhan
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Centre for Advancing Health Outcomes, St Paul's Hospital, Vancouver, BC, Canada; School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth C Gregory
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Afifa Humaira
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- Centre for Advancing Health Outcomes, St Paul's Hospital, Vancouver, BC, Canada; School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Levit
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Lisa Ridgway
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.
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Chen X, Blumberger DM, Downar J, Middleton VJ, Monira N, Bowman J, Kriske J, Kriske J, Donachie N, Kaster TS. Depressive symptom trajectories with prolonged rTMS treatment. Brain Stimul 2024; 17:525-532. [PMID: 38641170 DOI: 10.1016/j.brs.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/05/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND A prolonged repetitive transcranial magnetic stimulation (rTMS) treatment course could be beneficial for some patients experiencing major depressive episodes (MDE). We identified trajectories of rTMS response in depressive patients who received an extended rTMS treatment course and sought to determine which trajectories achieved the greatest benefit with a prolonged treatment course. METHOD We applied group-based trajectory modeling to a naturalistic dataset of depressive patients receiving a prolonged course of sequential bilateral rTMS (up to 51 treatment sessions) to the dorsolateral prefrontal cortex. Trajectories of the PHQ-9 with extended treatment courses were characterized, and we explored the association between baseline clinical characteristics and group membership using multinomial logistic regression. RESULTS Among the 324 study participants, four trajectories were identified: "linear response, extended course" (N = 73; 22.5 %); "nonresponse" (N = 23; 7.1 %); "slowed response" (N = 159; 49.1 %); "rapid response, standard treatment length" (N = 69; 21.3 %). Only the "linear response, extended course" group showed considerable clinical improvement after receiving additional rTMS treatments. Greater baseline depressive symptoms were associated with linear response and non-response. CONCLUSION Our results confirmed the distinctive response trajectories in depressive patients receiving rTMS and further highlighted that prolonged rTMS treatment courses may be beneficial for a subset of patients with higher initial symptom levels and linear early treatment response.
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Affiliation(s)
- Xiao Chen
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, 100101, China; Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China; Magnetic Resonance Imaging Research Center, Institute of Psychology, Chinese Academy of Sciences, Beijing, 100101, China; International Big-Data Center for Depression Research, Chinese Academy of Sciences, Beijing, 100101, China
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, M5T1R8, Ontario, Canada
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, M5T1R8, Ontario, Canada
| | | | - Naima Monira
- Salience Health Solutions, Plano, 75024, Texas, USA
| | | | | | - John Kriske
- Salience Health Solutions, Plano, 75024, Texas, USA
| | | | - Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, M6J1H4, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, M5T1R8, Ontario, Canada.
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3
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Goodman MS, Vila-Rodriguez F, Barwick M, Burke MJ, Downar J, Hunter J, Kaster TS, Knyahnytska Y, Kurdyak P, Maunder R, Thorpe K, Trevizol AP, Voineskos D, Zhang W, Blumberger DM. A randomized sham-controlled trial of high-dosage accelerated intermittent theta burst rTMS in major depression: study protocol. BMC Psychiatry 2024; 24:28. [PMID: 38191370 PMCID: PMC10773082 DOI: 10.1186/s12888-023-05470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Intermittent theta burst stimulation (iTBS), a novel form of repetitive transcranial magnetic stimulation (rTMS), can be administered in 1/10th of the time of standard rTMS (~ 3 min vs. 37.5 min) yet achieves similar outcomes in depression. The brief nature of the iTBS protocol allows for the administration of multiple iTBS sessions per day, thus reducing the overall course length to days rather than weeks. This study aims to compare the efficacy and tolerability of active versus sham iTBS using an accelerated regimen in patients with treatment-resistant depression (TRD). As a secondary objective, we aim to assess the safety, tolerability, and treatment response to open-label low-frequency right-sided (1 Hz) stimulation using an accelerated regimen in those who do not respond to the initial week of treatment. METHODS Over three years, approximately 230 outpatients at the Centre for Addiction and Mental Health and University of British Columbia Hospital, meeting diagnostic criteria for unipolar MDD, will be recruited and randomized to a triple blind sham-controlled trial. Patients will receive five consecutive days of active or sham iTBS, administered eight times daily at 1-hour intervals, with each session delivering 600 pulses of iTBS. Those who have not achieved response by the week four follow-up visit will be offered a second course of treatment, regardless of whether they initially received active or sham stimulation. DISCUSSION Broader implementation of conventional iTBS is limited by the logistical demands of the current standard course consisting of 4-6 weeks of daily treatment. If our proposed accelerated iTBS protocol enables patients to achieve remission more rapidly, this would offer major benefits in terms of cost and capacity as well as the time required to achieve clinical response. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04255784.
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Affiliation(s)
- Michelle S Goodman
- Temerty Centre for Therapeutic Brain Intervention, 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
| | - Melanie Barwick
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Matthew J Burke
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jonathan Downar
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Hunter
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Tyler S Kaster
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuliya Knyahnytska
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Robert Maunder
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Mount Sinai Hospital, Toronto, ON, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wei Zhang
- Centre for Advancing Health Outcomes, St Paul's Hospital, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Hutton TM, Aaronson ST, Carpenter LL, Pages K, Krantz D, Lucas L, Chen B, Sackeim HA. Dosing transcranial magnetic stimulation in major depressive disorder: Relations between number of treatment sessions and effectiveness in a large patient registry. Brain Stimul 2023; 16:1510-1521. [PMID: 37827360 DOI: 10.1016/j.brs.2023.10.001] [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: 08/07/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND The number of sessions in an acute TMS course for major depressive disorder (MDD) is greater than in the earlier randomized controlled trials. OBJECTIVE To compare clinical outcomes in groups that received differing numbers of TMS sessions. METHODS From a registry sample (N = 13,732), data were extracted for 7215 patients treated for MDD with PHQ-9 assessments before and after their TMS course. Groups were defined by number of acute course treatment sessions: 1-19 (N = 658), 20-29 (N = 616), 30-35 (N = 1375), 36 (N = 3591), 37-41 (N = 626), or >41 (N = 349) and compared in clinical outcomes at endpoint and at fixed intervals (after 10, 20, 30, and 36 sessions). The impact of additional treatments beyond 36 sessions was also examined. RESULTS Groups that received fewer than 30 sessions had inferior endpoint outcomes than all other groups. PHQ-9 symptom reduction was greatest in the group that ended treatment at 36 sessions. The extended treatment groups (>36 sessions) differed from all other groups by manifesting less antidepressant response early in the course and had a slower but steady rate of improvement over time. Extending treatment beyond 36 sessions was associated with further improvement without evidence of a plateau. CONCLUSIONS In real-world practice, there are strong relations between the number of TMS sessions in a course and the magnitude of symptom reduction. Courses with less than 30 sessions are associated with diminished benefit. Patients with longer than standard courses typically show less initial improvement and a more gradual trajectory, but meaningful benefit accrues with treatment beyond 36 sessions.
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Affiliation(s)
| | - Scott T Aaronson
- Sheppard Pratt Health System, Baltimore, MD, USA; Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - Linda L Carpenter
- Butler Hospital, Providence, RI, USA; Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | | | | | | | | | - Harold A Sackeim
- Department of Psychiatry, Columbia University, NY, USA; Department of Radiology, Columbia University, NY, USA.
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Shin H, Jeong H, Ryu W, Lee G, Lee J, Kim D, Song IU, Chung YA, Lee S. Robotic transcranial magnetic stimulation in the treatment of depression: a pilot study. Sci Rep 2023; 13:14074. [PMID: 37640754 PMCID: PMC10462606 DOI: 10.1038/s41598-023-41044-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
There has been an increasing demand for robotic coil positioning during repetitive transcranial magnetic stimulation (rTMS) treatment. Accurate coil positioning is crucial because rTMS generally targets specific brain regions for both research and clinical application with other reasons such as safety, consistency and reliability and individual variablity. Some previous studies have employed industrial robots or co-robots and showed they can more precisely stimulate the target cortical regions than traditional manual methods. In this study, we not only developed a custom-TMS robot for better TMS coil placement but also analyzed the therapeutic effects on depression. Treatment effects were evaluated by measuring regional cerebral blood flow (rCBF) using single-photon emission computed tomography and depression severity before and after rTMS for the two positioning methods. The rTMS preparation time with our robotic coil placement was reduced by 53% compared with that of the manual method. The position and orientation errors were also significantly reduced from 11.17 mm and 4.06° to 0.94 mm and 0.11°, respectively, confirming the superiority of robotic positioning. The results from clinical and neuroimaging assessments indicated comparable improvements in depression severity and rCBF in the left dorsolateral prefrontal cortex between the robotic and manual rTMS groups. A questionnaire was used to determine the patients' feelings about the robotic system, including the safety and preparation time. A high safety score indicated good acceptability of robotic rTMS at the clinical site.
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Affiliation(s)
- Hyunsoo Shin
- Department of Electrical and Electronic Engineering, Hanyang University, Ansan, 15588, Republic of Korea
| | - Hyeonseok Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - Wooseok Ryu
- Tesollo Inc., Gwangmyeong, 14353, Republic of Korea
| | - Geunhu Lee
- Department of Electrical and Electronic Engineering, Hanyang University, Ansan, 15588, Republic of Korea
| | - Jaeho Lee
- Department of Electrical and Electronic Engineering, Hanyang University, Ansan, 15588, Republic of Korea
| | - Doyu Kim
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - In-Uk Song
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea
| | - Yong-An Chung
- Department of Nuclear Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 21431, Republic of Korea.
| | - Sungon Lee
- Department of Electrical and Electronic Engineering, Hanyang University, Ansan, 15588, Republic of Korea.
- Department of Robotics, Hanyang University, Ansan, 15588, Republic of Korea.
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Minervini A, LaVarco A, Zorns S, Propper R, Suriano C, Keenan JP. Excitatory Dorsal Lateral Prefrontal Cortex Transcranial Magnetic Stimulation Increases Social Anxiety. Brain Sci 2023; 13:989. [PMID: 37508921 PMCID: PMC10377502 DOI: 10.3390/brainsci13070989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Social exclusion refers to the experience of rejection by one or more people during a social event and can induce pain-related sensations. Cyberball, a computer program, is one of the most common tools for analyzing social exclusion. Regions of the brain that underlie social pain include networks linked to the dorsal lateral prefrontal cortex (DLPFC). Specifically, self-directed negative socially induced exclusion is associated with changes in DLPFC activity. Direct manipulation of this area may provide a better understanding of how the DLPFC can influence the perception of social exclusion and determine a causal role of the DLPFC. Transcranial magnetic stimulation (TMS) was applied to both the left and right DLPFC to gauge different reactions to the Cyberball experience. It was found that there were elevated exclusion indices following right DLPFC rTMS; participants consistently felt more excluded when the right DLPFC was excited. This may relate to greater feelings of social pain when the right DLPFC is manipulated. These data demonstrate that direct manipulation of the DLPFC results in changes in responses to social exclusion.
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Affiliation(s)
- Anthony Minervini
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Adriana LaVarco
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Samantha Zorns
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Ruth Propper
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Christos Suriano
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
| | - Julian Paul Keenan
- Cognitive Neuroimaging Laboratory, Montclair State University, Montclair, NJ 07043, USA
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Boscutti A, Murphy N, Cho R, Selvaraj S. Noninvasive Brain Stimulation Techniques for Treatment-Resistant Depression: Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation. Psychiatr Clin North Am 2023; 46:307-329. [PMID: 37149347 DOI: 10.1016/j.psc.2023.02.005] [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] [Indexed: 05/08/2023]
Abstract
Transcranial magnetic stimulation is a safe, effective, and well-tolerated intervention for depression; it is currently approved for treatment-resistant depression. This article summarizes the mechanism of action, evidence of clinical efficacy, and the clinical aspects of this intervention, including patient evaluation, stimulation parameters selection, and safety considerations. Transcranial direct current stimulation is another neuromodulation treatment for depression; although promising, the technique is not currently approved for clinical use in the United States. The final section outlines the open challenges and future directions of the field.
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Affiliation(s)
- Andrea Boscutti
- Louis. A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Nicholas Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - Raymond Cho
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX, USA; The Menninger Clinic, Houston, TX, USA
| | - Sudhakar Selvaraj
- Louis. A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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8
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Ekman CJ, Popiolek K, Bodén R, Nordenskjöld A, Lundberg J. Outcome of transcranial magnetic intermittent theta-burst stimulation in the treatment of depression - A Swedish register-based study. J Affect Disord 2023; 329:50-54. [PMID: 36841303 DOI: 10.1016/j.jad.2023.02.098] [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: 10/24/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an established treatment of depression. The more recently introduced intermittent Theta-burst stimulation (iTBS) has shown significant superiority over sham-stimulation and equal effect sizes to a 10 Hz protocol in one clinical trial. The aim of the current study was to investigate the effectiveness and tolerability of iTBS in a naturalistic, clinical setting. Further, we explored demographical and clinical predictors of response. METHODS Data was collected from seventeen rTMS-sites in Sweden between January 2018 and May 2021, through the Swedish National Quality register for repetitive Transcranial Magnetic Stimulation (Q-rTMS). We included 542 iTBS-treated patients with unipolar or bipolar depression. Outcome was assessed with Clinical Global Impression Severity and Improvement scores in an intention to treat analysis. RESULTS The response rate was 42.1 % and 16.1 % reached remission. The response rate was significantly larger in the oldest age group compared to the youngest (odds ratio 3.46, 95 % confidence interval 1.65-7.22). Less severe level of depression (Montgomery-Åsberg depression rating scale self-assessment < 36) at baseline predicted response and remission. Only <1 % were much or very much worse after treatment. Drop-out rate was 10.9 %. No serious adverse events were reported. LIMITATIONS Retrospective analysis of register data. No comparison group. CONCLUSIONS In a clinical setting, iTBS was shown to be safe and tolerable and the response rate was similar to that reported from clinical trials. Older age-group and less severe illness predicted response.
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Affiliation(s)
- Carl Johan Ekman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Katarzyna Popiolek
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
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9
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Chen L, Klooster DCW, Tik M, Thomas EHX, Downar J, Fitzgerald PB, Williams NR, Baeken C. Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future. Harv Rev Psychiatry 2023; 31:142-161. [PMID: 37171474 PMCID: PMC10188211 DOI: 10.1097/hrp.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective and evidence-based therapy for treatment-resistant major depressive disorder. A conventional course of rTMS applies 20-30 daily sessions over 4-6 weeks. The schedule of rTMS delivery can be accelerated by applying multiple stimulation sessions per day, which reduces the duration of a treatment course with a predefined number of sessions. Accelerated rTMS reduces time demands, improves clinical efficiency, and potentially induces faster onset of antidepressant effects. However, considerable heterogeneity exists across study designs. Stimulation protocols vary in parameters such as the stimulation target, frequency, intensity, number of pulses applied per session or over a course of treatment, and duration of intersession intervals. In this article, clinician-researchers and neuroscientists who have extensive research experience in accelerated rTMS synthesize a consensus based on two decades of investigation and development, from early studies ("Past") to contemporaneous theta burst stimulation, a time-efficient form of rTMS gaining acceptance in clinical settings ("Present"). We propose descriptive nomenclature for accelerated rTMS, recommend avenues to optimize therapeutic and efficiency potential, and suggest using neuroimaging and electrophysiological biomarkers to individualize treatment protocols ("Future"). Overall, empirical studies show that accelerated rTMS protocols are well tolerated and not associated with serious adverse effects. Importantly, the antidepressant efficacy of accelerated rTMS appears comparable to conventional, once daily rTMS protocols. Whether accelerated rTMS induces antidepressant effects more quickly remains uncertain. On present evidence, treatment protocols incorporating high pulse dose and multiple treatments per day show promise and improved efficacy.
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Affiliation(s)
- Leo Chen
- From the Monash Alfred Psychiatry Research Centre, Department of Psychiatry, Central Clinical School, Monash University, Melbourne, Australia (Drs. Chen, Thomas); Ghent Experimental Psychiatry (GHEP) Lab, Department of Head and Skin (UZGent), Ghent University, Ghent, Belgium (Drs. Klooster, Baeken); Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford University, Stanford, CA (Drs. Tik, Williams); Institute of Medical Science and Department of Psychiatry, University of Toronto, Canada (Dr. Downar); School of Medicine and Psychology, he Australian National University, Canberra, Australia (Dr. Fitzgerald)
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10
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Jiang W, Isenhart R, Liu CY, Song D. A C-shaped miniaturized coil for transcranial magnetic stimulation in rodents. J Neural Eng 2023; 20:026022. [PMID: 36863013 PMCID: PMC10037933 DOI: 10.1088/1741-2552/acc097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/09/2023] [Accepted: 03/02/2023] [Indexed: 03/04/2023]
Abstract
Objective.Transcranial magnetic stimulation (TMS) is a non-invasive technique widely used for neuromodulation. Animal models are essential for investigating the underlying mechanisms of TMS. However, the lack of miniaturized coils hinders the TMS studies in small animals, since most commercial coils are designed for humans and thus incapable of focal stimulation in small animals. Furthermore, it is difficult to perform electrophysiological recordings at the TMS focal point using conventional coils.Approach.We designed, fabricated, and tested a novel miniaturized TMS coil (4-by-7 mm) that consisted of a C-shaped iron powder core and insulated copper wires (30 turns). The resulting magnetic and electric fields were characterized with experimental measurements and finite element modeling. The efficacy of this coil in neuromodulation was validated with electrophysiological recordings of single-unit activities (SUAs), somatosensory evoked potentials (SSEPs), and motor evoked potentials (MEPs) in rats (n= 32) following repetitive TMS (rTMS; 3 min, 10 Hz).Main results.This coil could generate a maximum magnetic field of 460 mT and an electric field of 7.2 V m-1in the rat brain according to our simulations. With subthreshold rTMS focally delivered over the sensorimotor cortex, mean firing rates of primary somatosensory and motor cortical neurons significantly increased (154±5% and 160±9% from the baseline level, respectively); MEP and SSEP amplitude significantly increased (136±9%) and decreased (74±4%), respectively.Significance.This miniaturized C-shaped coil enabled focal TMS and concurrent electrophysiological recording/stimulation at the TMS focal point. It provided a useful tool to investigate the neural responses and underlying mechanisms of TMS in small animal models. Using this paradigm, we for the first time observed distinct modulatory effects on SUAs, SSEPs, and MEPs with the same rTMS protocol in anesthetized rats. These results suggested that multiple neurobiological mechanisms in the sensorimotor pathways were differentially modulated by rTMS.
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Affiliation(s)
- Wenxuan Jiang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
| | - Robert Isenhart
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States of America
- USC Neurorestoration Center, University of Southern California, Los Angeles, CA, United States of America
| | - Charles Y Liu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, United States of America
- USC Neurorestoration Center, University of Southern California, Los Angeles, CA, United States of America
- Department of Neurological Surgery, University of Southern California, Los Angeles, CA, United States of America
| | - Dong Song
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States of America
- USC Neurorestoration Center, University of Southern California, Los Angeles, CA, United States of America
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11
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Noda Y, Sato A, Shichi M, Sato A, Fujii K, Iwasa M, Nagano Y, Kitahata R, Osawa R. Real world research on transcranial magnetic stimulation treatment strategies for neuropsychiatric symptoms with long-COVID in Japan. Asian J Psychiatr 2023; 81:103438. [PMID: 36610206 PMCID: PMC9795803 DOI: 10.1016/j.ajp.2022.103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022]
Abstract
The number of patients suffering from long-COVID is currently increasing rapidly, even after the acute symptoms of COVID-19 have improved. The objective of this study was to investigate the effects of a pilot transcranial magnetic stimulation (TMS) treatment on neuropsychiatric symptoms caused by long-COVID. In this study, we examined the efficacy of the TMS treatment protocol, which has been established to be effective in refractory depression, by applying it to patients who sought TMS treatment for neuropsychiatric symptoms caused by long-COVID at TMS clinics in Tokyo, Japan in the context of the real world TMS registry study in Japan. Of the 23 patients (13 females) with long-COVID included in this case series, the main neuropsychiatric symptoms were chronic fatigue (n = 12) and cognitive dysfunction (n = 11), but most patients also showed mild depressive symptoms. The mean score on the Montgomery-Åsberg Depression Rating Scale before TMS treatment was 21.2, which improved to 9.8 after treatment. Similarly, the score on the Performance Status, which assesses the degree of fatigue, improved from 5.4 to 4.2, and the score on the Perceived Deficits Questionnaire-Depression 5-item, which reflects cognitive function, improved from 10.0 to 6.3. Although a few patients complained of pain at the stimulation site during the TMS as a side effect, there were no serious adverse events. Despite the limitations of this open-label pilot study, the TMS protocol implemented in this study may have beneficial effects on neuropsychiatric symptoms caused by long-COVID, including depressive symptoms, chronic fatigue, and cognitive impairment. These preliminary findings warrant further validation in randomized controlled trials.
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Affiliation(s)
- Yoshihiro Noda
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
| | | | | | | | | | - Mio Iwasa
- Shinjuku-Yoyogi Mental Lab Clinic, Tokyo, Japan
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Extension of transcranial magnetic stimulation treatment for depression in non-responders: Results of a naturalistic study. J Psychiatr Res 2023; 158:314-318. [PMID: 36628873 DOI: 10.1016/j.jpsychires.2022.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) shows efficacy in the treatment of major depressive disorder using a standard course of 20-36 treatment sessions. However, research efforts are being made to improve overall response and remission rates. Evidence from open-label extension studies of randomized control trials suggests that extending the rTMS treatment course beyond 36 treatments may improve outcomes, however, little has been published on the benefit of extended TMS treatment courses in clinical practice. OBJECTIVE In this retrospective naturalistic observational study, we studied response rates on continuation of rTMS following failure of the first round of 36 treatments. METHODS From 142 patients who received conventional rTMS and 29 who underwent theta-burst stimulation (TBS) at Massachusetts General Hospital TMS clinical service, 28 non-responders (23 to rTMS and 5 to TBS) opted to continue their treatment beyond session 36. The treatment protocol allowed personalization in target, TMS protocol, as well as number of pulses and sessions as clinically indicated. Sustained response and remission using Hamilton Rating Scale for Depression, 17-items (HAMD-17) was the primary outcome. RESULTS The average number of overall treatment sessions was 70.54 ± 16.73 for the sample. Overall, there was a 53.57% response rate and a 32.14% remission rate. Response and remission rates rose as the number of sessions increased and there did not appear to be a plateau in response over time. CONCLUSION Our results support the idea that subpopulation of TMS patients are late responders. Continuation of TMS up to 72 treatments among those patients who do not meet response criteria by session 36 may improve overall response rates. While the number of subjects and study design limit generalization, given the fact that these patients were medication refractory and had failed initial course of TMS, the result of this study is encouraging.
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The Use of Repetitive Transcranial Magnetic Stimulations for the Treatment of Bipolar Disorder: A Scoping Review. Behav Sci (Basel) 2022; 12:bs12080263. [PMID: 36004834 PMCID: PMC9404915 DOI: 10.3390/bs12080263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulation technique that involves the application of magnetic pulses on hyperactive or hypoactive cortical brain areas. rTMS is considered a high therapeutic tool in many neuropsychiatric conditions. Despite its wide and continuous usage for the treatment of psychiatric disorders, information about the use of rTMS in bipolar disorders is limited and not well-established in the literature. Objectives: This scoping review aims to explore the literature available regarding the application of rTMS for the management of bipolar disorders, to garner evidence in support of it uses in the management of bipolar disorders, and for recommendations on future clinical and research work. Method: We electronically conducted a data search in five research databases (MEDLINE, CINAHL, Psych INFO, SCOPUS, and EMBASE) using all identified keywords across all the databases to identify evidence-based studies. Articles were included if they were published randomized control designs aimed at the use of rTMS in the management of bipolar disorders. Overall, nine studies were eligible for this review. The search results are up to date as of the final date of data search—20 December 2020. Only full-text published articles written in English were reviewed. Review articles on treatment with rTMS for conditions either than bipolar disorders were excluded. Conclusion: The application of rTMS intervention for bipolar disorders looks promising despite the diversity of its outcomes and its clinical significance. However, to be able to draw a definite conclusion on the clinical effectiveness of the technique, more randomized controlled studies with well-defined stimulation parameters need to be conducted with large sample sizes in the future.
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Nardone R, Sebastianelli L, Versace V, Ferrazzoli D, Brigo F, Schwenker K, Saltuari L, Trinka E. TMS for the functional evaluation of cannabis effects and for treatment of cannabis addiction: A review. Psychiatry Res 2022; 310:114431. [PMID: 35219263 DOI: 10.1016/j.psychres.2022.114431] [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] [Received: 03/28/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022]
Abstract
The knowledge about the effects of cannabis on human cortical brain processes is increasing. In this regard, transcranial magnetic stimulation (TMS) enables the evaluation of central nervous system function, including drug effects. Moreover, repetitive TMS (rTMS) has been used therapeutically in several substance use disorders. In this scoping review, we summarize and discuss studies that have employed TMS and rTMS techniques in users of cannabis for recreational purposes. In subjects with a history of persistent cannabis use, TMS studies showed reduced short-interval cortical inhibition (SICI). This observation points more at neurobiological changes of chronic cannabis use than to a direct effect of cannabis on gamma-aminobutyric acid (GABA) A receptors. Moreover, individuals vulnerable to becoming long-term users of cannabis may also have underlying pre-existing abnormalities in SICI. Of note, the use of cannabis is associated with an increased risk of schizophrenia, and the down-regulation of GABAergic function may play a role. Less frequent cannabis use and spontaneous craving were observed following rTMS applied to the dorsolateral prefrontal cortex (DLPFC). There is emerging evidence that the posterior cingulate cortex and the precuneus are potential targets for rTMS intervention in cannabis use disorder. However, larger and randomized trials should corroborate these encouraging findings.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Kerstin Schwenker
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; UMIT, University for Medical Informatics and Health Technology, Hall in Tirol, Austria
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15
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Marder KG, Barbour T, Ferber S, Idowu O, Itzkoff A. Psychiatric Applications of Repetitive Transcranial Magnetic Stimulation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:8-18. [PMID: 35746935 PMCID: PMC9063593 DOI: 10.1176/appi.focus.20210021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Transcranial magnetic stimulation (TMS) is an increasingly popular noninvasive brain stimulation modality. In TMS, a pulsed magnetic field is used to noninvasively stimulate a targeted brain region. Repeated stimulation produces lasting changes in brain activity via mechanisms of synaptic plasticity similar to long-term potentiation. Local application of TMS alters activity in distant, functionally connected brain regions, indicating that TMS modulates activity of cortical networks. TMS has been approved by the U.S. Food and Drug Administration for the treatment of major depressive disorder, obsessive-compulsive disorder, and smoking cessation, and a growing evidence base supports its efficacy in the treatment of other neuropsychiatric conditions. TMS is rapidly becoming part of the standard of care for treatment-resistant depression, where it yields response rates of 40%-60%. TMS is generally safe and well tolerated; its most serious risk is seizure, which occurs very rarely. This review aims to familiarize practicing psychiatrists with basic principles of TMS, including target localization, commonly used treatment protocols and their outcomes, and safety and tolerability. Practical considerations, including evaluation and monitoring of patients undergoing TMS, device selection, treatment setting, and insurance reimbursement, are also reviewed.
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16
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Li J, Cui L, Li H. Optimal parameter determination of repetitive transcranial magnetic stimulation for treating treatment-resistant depression: A network meta-analysis of randomized controlled trials. Front Psychiatry 2022; 13:1038312. [PMID: 36532172 PMCID: PMC9751374 DOI: 10.3389/fpsyt.2022.1038312] [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: 09/06/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many studies have shown the efficacy of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD). However, the choice of different parameters has been a challenging issue. METHODS PubMed, Cochrane, and Embase databases were searched for relevant studies until June 20, 2022. The treatment efficacy was evaluated by the relative risk (RR) using the pairwise test for response and remission rates. Subgroup and sensitivity analyses were conducted to explore the primary outcome differences and to assess the reliability of the results. RESULTS Thirty-seven trials comprising 2120 participants with TRD were included. The more efficacious interventions compared to sham controls included high-frequency left followed by low-frequency right sup-threshold (HFL-LFR-sup-rTMS, RR = 5.29, 95% CI: 1.24-22.50), high-frequency left sup-threshold (HFL-sup-rTMS, RR = 2.97, 95% CI: 1.74-5.05), low-frequency right sup-threshold (LFR-sup-rTMS, RR = 2.72, 95% CI: 1.50-4.90), low-frequency right followed by high-frequency left sup-threshold (LFR-HFL-sup-rTMS, RR = 2.71, 95% CI: 1.62-4.53), and high-frequency left sub-threshold (HFL-sub-rTMS, RR = 1.91, 95% CI: 1.18-3.10) rTMS. The estimated relative ranking of treatments suggested that HFL-LFR-sup-rTMS (84.4%) might be the most efficacious among all rTMS strategies. No treatments showed a lower acceptability than the sham control. LIMITATIONS Subgroup analysis was not conducted to compare the efficacy of rTMS treatment between bipolar and unipolar depression, and small-study effects possibly introduced bias. CONCLUSION Treatment with HFL-LFR-sup-rTMS, HFL-sup-rTMS, LFR-sup-rTMS, LFR-HFL-sup-rTMS, or HFL-sub-rTMS is more efficacious than the sham control. HFL-LFR-sup-rTMS and HFL-sup-rTMS may be the two best among the most efficacious rTMS treatments. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022334481].
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Affiliation(s)
- Jinbiao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Liqian Cui
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Hao Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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17
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A transcranial magnetic stimulation protocol for decreasing the craving of methamphetamine-dependent patients. STAR Protoc 2021; 2:100944. [PMID: 34825214 PMCID: PMC8603307 DOI: 10.1016/j.xpro.2021.100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation technique. Many substance use disorders lack effective treatments, and TMS is expected to reduce cravings and risk of relapse by regulating brain function. Here, we introduce three alternative TMS settings and specific operations to interfere with methamphetamine use disorders. Theoretically, this protocol can also be applied to diseases with similar brain damage characteristics. For complete details on the use and execution of this protocol, please refer to Chen et al. (2020).
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18
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Adu MK, Eboreime E, Sapara AO, Greenshaw AJ, Chue P, Agyapong VIO. The use of repetitive transcranial magnetic stimulation for treatment of obsessive-compulsive disorder: a scoping review. Ment Illn 2021; 13:1-13. [PMID: 35432816 PMCID: PMC8936147 DOI: 10.1108/mij-05-2021-0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose This paper aims to explore the relevant literature available regarding the use of repetitive transcranial magnetic stimulation (rTMS) as a mode of treatment for obsessive-compulsive disorder (OCD); to evaluate the evidence to support the use of rTMS as a treatment option for OCD. Design/methodology/approach The authors electronically conducted data search in five research databases (MEDLINE, CINAHL, Psych INFO, SCOPUS and EMBASE) using all identified keywords and index terms across all the databases to identify empirical studies and randomized controlled trials. The authors included articles published with randomized control designs, which aimed at the treatment of OCD with rTMS. Only full-text published articles written in English were reviewed. Review articles on treatment for conditions other than OCD were excluded. The Covidence software was used to manage and streamline the review. Findings Despite the inconsistencies in the published literature, the application of rTMS over the supplementary motor area and the orbitofrontal cortex has proven to be promising in efficacy and tolerability compared with other target regions such as the prefrontal cortex for the treatment of OCD. Despite the diversity in terms of the outcomes and clinical variability of the studies under review, rTMS appears to be a promising treatment intervention for OCD. Research limitations/implications The authors of this scoping review acknowledge several limitations. First, the search strategy considered only studies published in English and the results are up to date as the last day of the electronic data search of December 10, 2020. Though every effort was made to identify all relevant studies for the purposes of this review per the eligibility criteria, the authors still may have missed some relevant studies, especially those published in other languages. Originality/value This review brought to bare the varying literature on the application of rTMS and what is considered gaps in the knowledge in this area in an attempt to evaluate and provide information on the potential therapeutic effects of rTMS for OCD.
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Affiliation(s)
- Medard Kofi Adu
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta Edmonton Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta Edmonton Canada
| | | | - Andrew James Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta Edmonton Canada
| | - Pierre Chue
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta Edmonton Canada
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19
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Che X, Cash RFH, Luo X, Luo H, Lu X, Xu F, Zang YF, Fitzgerald PB, Fitzgibbon BM. High-frequency rTMS over the dorsolateral prefrontal cortex on chronic and provoked pain: A systematic review and meta-analysis. Brain Stimul 2021; 14:1135-1146. [PMID: 34280583 DOI: 10.1016/j.brs.2021.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND High-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) has demonstrated mixed effects on chronic and provoked pain. OBJECTIVES/METHODS In this study, a meta-analysis was conducted to characterise the potential analgesic effects of high-frequency rTMS over the DLPFC on both chronic and provoked pain. RESULTS A total of 626 studies were identified in a systematic search. Twenty-six eligible studies were included for the quantitative review, among which 17 modulated chronic pain and the remaining investigated the influence on provoked pain. The left side DLPFC was uniformly targeted in the chronic pain studies. While our data identified no overall effect of TMS across chronic pain conditions, there was a significant short-term analgesia in neuropathic pain conditions only (SMD = -0.87). In terms of long-lasting analgesia, there was an overall pain reduction in the midterm (SMD = -0.53, 24.6 days average) and long term (SMD = -0.63, 3 months average) post DLPFC stimulation, although these effects were not observed within specific chronic pain conditions. Surprisingly, the number of sessions was demonstrated to have no impact on rTMS analgesia. In the analysis of provoked pain, our data also indicated a significant analgesic effect following HF-rTMS over the DLPFC (SMD = -0.73). Importantly, we identified a publication bias in the studies of provoked pain but not for chronic pain conditions. CONCLUSIONS Overall, our findings support that HF-DLPFC stimulation is able to induce an analgesic effect in chronic pain and in response to provoked pain. These results highlight the potential of DLPFC-rTMS in the management of certain chronic pain conditions and future directions are discussed to enhance the potential long-term analgesic effects.
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Affiliation(s)
- Xianwei Che
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.
| | - Robin F H Cash
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Victoria, Australia; Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia
| | - Xi Luo
- Shenzhen Key Laboratory of Affective and Social Cognitive Science, School of Psychology, Shenzhen University, Shenzhen, China
| | - Hong Luo
- Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xiaodong Lu
- Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Feng Xu
- Shenzhen Yingchi Technology Co., Ltd, China
| | - Yu-Feng Zang
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Department of Psychiatry, Victoria, Australia
| | - Bernadette M Fitzgibbon
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
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20
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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] [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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21
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Cosmo C, Zandvakili A, Petrosino NJ, Berlow YA, Philip NS. Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression: Recent Critical Advances in Patient Care. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2021; 8:47-63. [PMID: 33723500 PMCID: PMC7946620 DOI: 10.1007/s40501-021-00238-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Transcranial magnetic stimulation (TMS) is an evidence-based treatment for pharmacoresistant major depressive disorder (MDD). In the last decade, the field has seen significant advances in the understanding and use of this new technology. This review aims to describe the large, randomized controlled studies leading to the modern use of rTMS for MDD. It also includes a special section briefly discussing the use of these technologies during the COVID-19 pandemic. RECENT FINDINGS Several new approaches and technologies are emerging in this field, including novel approaches to reduce treatment time and potentially yield new approaches to optimize and maximize clinical outcomes. Of these, theta burst TMS now has evidence indicating it is non-inferior to standard TMS and provides significant advantages in administration. Recent studies also indicate that neuroimaging and related approaches may be able to improve TMS targeting methods and potentially identify those patients most likely to respond to stimulation. SUMMARY While new data is promising, significant research remains to be done to individualize and optimize TMS procedures. Emerging new approaches, such as accelerated TMS and advanced targeting methods, require additional replication and demonstration of real-world clinical utility. Cautious administration of TMS during the pandemic is possible with careful attention to safety procedures.
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Affiliation(s)
- Camila Cosmo
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, 830 Chalkstone Ave, Providence, 02908 USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Amin Zandvakili
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, 830 Chalkstone Ave, Providence, 02908 USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Nicholas J. Petrosino
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, 830 Chalkstone Ave, Providence, 02908 USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Yosef A. Berlow
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, 830 Chalkstone Ave, Providence, 02908 USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Noah S. Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Healthcare System, 830 Chalkstone Ave, Providence, 02908 USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
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22
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Noda Y. Potential Neurophysiological Mechanisms of 1Hz-TMS to the Right Prefrontal Cortex for Depression: An Exploratory TMS-EEG Study in Healthy Participants. J Pers Med 2021; 11:jpm11020068. [PMID: 33498917 PMCID: PMC7910865 DOI: 10.3390/jpm11020068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The present study aimed to examine the acute neurophysiological effects of 1Hz transcranial magnetic stimulation (TMS) administered to the right dorsolateral prefrontal cortex (DLPFC) in healthy participants. METHODS TMS combined with simultaneous electroencephalography (EEG) recording was conducted for 21 healthy participants. For the right DLPFC, 1Hz-TMS (100 pulses/block × 17 sessions) was applied in the resting-state, while for the left DLPFC, 1Hz-TMS (100 pulses/block × 2 sessions) was administered during the verbal fluency tasks (VFTs). For TMS-EEG data, independent component analysis (ICA) was applied to extract TMS-evoked EEG potentials to calculate TMS-related power as well as TMS-related coherence from the F4 and F3 electrode sites during the resting-state and VFTs. RESULTS TMS-related power was significantly increased in alpha, beta, and gamma bands by 1Hz-TMS at the stimulation site during the resting-state, while TMS-related power was significantly increased in alpha and beta bands but not in the gamma band during the VFTs. On the other hand, TMS-related coherence in alpha and beta bands significantly increased but not in gamma band by 1Hz-TMS that was administered to the right DLPFC in resting-state, whereas there were no significant changes in coherence for all frequency bands by 1Hz-TMS that applied to the left DLPFC during the VFTs. CONCLUSIONS Collectively, 1Hz-repetitive TMS (rTMS) to the right DLPFC may rapidly neuromodulate EEG activity, which might be associated with a therapeutic mechanism for depression.
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Affiliation(s)
- Yoshihiro Noda
- Department of Neuropsychiatry, Graduate School of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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23
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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: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [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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24
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Fitzgerald PB. An update on the clinical use of repetitive transcranial magnetic stimulation in the treatment of depression. J Affect Disord 2020; 276:90-103. [PMID: 32697721 DOI: 10.1016/j.jad.2020.06.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an increasingly used treatment for patients with depression. The use of rTMS in depression is supported by over 20 years of clinical trials. There has been a significant increase in knowledge around the use of rTMS in recent years. OBJECTIVE The aim of this paper was to review the use of rTMS in depression to provide an update for rTMS practitioners and clinicians interested in the clinical use of this treatment. METHODS A targeted review of the literature around the use of rTMS treatment of depression with a specific focus on studies published in the last 3 years. RESULTS High-frequency rTMS applied to the left dorsolateral prefrontal cortex is an effective treatment for acute episodes of major depressive disorder. There are several additional methods of rTMS delivery that are supported by clinical trials and meta-analyses but no substantive evidence that any one approach is any more effective than any other. rTMS is effective in unipolar depression and most likely bipolar depression. rTMS courses may be repeated in the management of depressive relapse but there is less evidence for the use of rTMS in the maintenance phase. CONCLUSIONS The science around the use of rTMS is rapidly evolving and there is a considerable need for practitioners to remain abreast of the current state of this literature and its implications for clinical practice. rTMS is an effective antidepressant treatment but its optimal use should be continually informed by knowledge of the state of the art.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Central Clinical School, 888 Toorak Rd, Camberwell, Victoria 3004, Australia.
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25
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Abou El-Magd RM, Obuobi-Donkor G, Adu MK, Lachowski C, Duddumpudi S, Lawal MA, Sapara AO, Achor M, Kouzehgaran M, Hegde R, Chew C, Mach M, Daubert S, Urichuk L, Snaterse M, Surood S, Li D, Greenshaw A, Agyapong VIO. Repetitive Transcranial Magnetic Stimulation With and Without Internet-Delivered Cognitive-Behavioral Therapy for the Treatment of Resistant Depression: Protocol for Patient-Centered Randomized Controlled Pilot Trial. JMIR Res Protoc 2020; 9:e18843. [PMID: 33107835 PMCID: PMC7655463 DOI: 10.2196/18843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/25/2020] [Accepted: 08/11/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Major depression is a severe, disabling, and potentially lethal clinical disorder. Only about half of patients respond to an initial course of antidepressant pharmacotherapy. At least 15% of all patients with major depressive disorder (MDD) remain refractory to any treatment intervention. By the time that a patient has experienced 3 definitive treatment failures, the likelihood of achieving remission with the fourth treatment option offered is below 10%. Repetitive transcranial magnetic stimulation (rTMS) is considered a treatment option for patients with MDD who are refractory to antidepressant treatment. It is not currently known if the addition of internet-delivered cognitive-behavioral therapy (iCBT) enhances patients' responses to rTMS treatments. OBJECTIVE This study will evaluate the initial comparative clinical effectiveness of rTMS with and without iCBT as an innovative patient-centered intervention for the treatment of participants diagnosed with treatment-resistant depression (TRD). METHODS This study is a prospective, two-arm randomized controlled trial. In total, 100 participants diagnosed with resistant depression at a psychiatric care clinic in Edmonton, Alberta, Canada, will be randomized to one of two conditions: (1) enrolment in rTMS sessions alone and (2) enrolment in the rTMS sessions plus iCBT. Participants in each group will complete evaluation measures (eg, recovery, general symptomatology, and functional outcomes) at baseline, 1 month, 3 months, and 6 months. The primary outcome measure will be the mean change to scores on the Hamilton Depression Rating Scale. Patient service utilization data and clinician-rated measures will also be used to gauge patient progress. Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses. RESULTS We expect the results of the study to be available in 24 months. We hypothesize that participants enrolled in the study who receive rTMS plus iCBT will achieve superior outcomes in comparison to participants who receive rTMS alone. CONCLUSIONS The concomitant application of psychotherapy with rTMS has not been investigated previously. We hope that this project will provide us with a concrete base of data to evaluate the practical application and efficacy of using a novel combination of these two treatment modalities (rTMS plus iCBT). TRIAL REGISTRATION ClinicalTrials.gov NCT0423965; https://clinicaltrials.gov/ct2/show/NCT04239651. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/18843.
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Affiliation(s)
- Rabab M Abou El-Magd
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gloria Obuobi-Donkor
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Medard K Adu
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christopher Lachowski
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Surekha Duddumpudi
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mobolaji A Lawal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Adegboyega O Sapara
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael Achor
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Maryam Kouzehgaran
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Roshan Hegde
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Corina Chew
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Mike Mach
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shelley Daubert
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Liana Urichuk
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Mark Snaterse
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Daniel Li
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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The exploration of optimized protocol for repetitive transcranial magnetic stimulation in the treatment of methamphetamine use disorder: A randomized sham-controlled study. EBioMedicine 2020; 60:103027. [PMID: 32980696 PMCID: PMC7522737 DOI: 10.1016/j.ebiom.2020.103027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/21/2020] [Accepted: 09/10/2020] [Indexed: 12/21/2022] Open
Abstract
Background The prefrontal-striatal circuit is a core circuit related to substance dependence. Previous studies have found that repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex (DLPFC) (key region of executive network) had limited responses, while inhibiting hyperactivation of ventromedial prefrontal cortex (vmPFC) (key region of limbic network) may be another strategy. However, there is currently no comparison between these two treatment locations. Methods Seventy-four methamphetamine-dependent patients were randomly assigned to one of treatment groups with two-week treatment: (1) Group A: intermittent theta-burst stimulation (iTBS) targeting the left DLPFC; (2) Group B: continuous theta-burst stimulation (cTBS) targeting the left vmPFC; (3) Group C: a combination of treatment protocol of Group A and Group B; (4) Group D: sham theta-burst stimulation. The primary endpoint was the change of cue-induced craving. The trial was registered at ClinicalTrials.gov (NCT03736317). Findings The three real TBS groups had more craving decrease effect than the sham group (p<0.01). The changes of craving were positively correlated with the improvement of anxiety and withdrawal symptom. With the highest respondence rate, group C also had shorter respondence time than Group A (p = 0.03). Group C was effective in improve depression symptoms (p = 0.04) and withdrawal symptom (p = 0.02) compared with Group D. Besides, Group C was significant in improve sleep quality (p = 0.04) compared with Group A. Baseline depression scores and spatial working memory were positively predicting the intervention response. Interpretation The rTMS paradigms involving vmPFC with cTBS are optimized protocols and well-tolerated for methamphetamine-dependent individuals, and they may have better efficacies compared with DLPFC iTBS. Emotion and cognitive function are rTMS treatment response predictors for methamphetamine-dependent patients. Funding This work was supported by the National Key R&D Program of China (2017YFC1310400), National Natural Science Foundation of China (81,771,436, 81,801,319, 81,601,164), Shanghai Municipal Health and Family Planning Commission (2017ZZ02021), Municipal Human Resources Development Program for Outstanding Young Talents in Medical and Health Sciences in Shanghai (2017YQ013), Qihang Project of Shanghai Mental Health Center (2019-QH-05), Shanghai Sailing Program (19YF1442100), Shanghai Key Laboratory of Psychotic Disorders (13DZ2260500), Program of Shanghai Academic Research Leader (17XD1403300), Shanghai Municipal Science and Technology Major Project (2018SHZDZX05), and Shanghai Clinical Research Center for Mental Health (19MC1911100).
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Moreno-Ortega M, Kangarlu A, Lee S, Perera T, Kangarlu J, Palomo T, Glasser MF, Javitt DC. Parcel-guided rTMS for depression. Transl Psychiatry 2020; 10:283. [PMID: 32788580 PMCID: PMC7423622 DOI: 10.1038/s41398-020-00970-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is an approved intervention for treatment-resistant depression (TRD), but current targeting approaches are only partially successful. Our objectives were (1) to examine the feasibility of MRI-guided TMS in the clinical setting using a recently published surface-based, multimodal parcellation in patients with TRD who failed standard TMS (sdTMS); (2) to examine the neurobiological mechanisms and clinical outcomes underlying MRI-guided TMS compared to that of sdTMS. We used parcel-guided TMS (pgTMS) to target the left dorsolateral prefrontal cortex parcel 46. Resting-state functional connectivity (rsfc) was assessed between parcel 46 and predefined nodes within the default mode and visual networks, following both pgTMS and sdTMS. All patients (n = 10) who had previously failed sdTMS responded to pgTMS. Alterations in rsfc between frontal, default mode, and visual networks differed significantly over time between groups. Improvements in symptoms correlated with alterations in rsfc within each treatment group. The outcome of our study supports the feasibility of pgTMS within the clinical setting. Future prospective, double-blind studies of pgTMS vs. sdTMS appear warranted.
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Affiliation(s)
- M. Moreno-Ortega
- Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute/Columbia University Medical Center, New York, NY USA ,grid.469673.9Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - A. Kangarlu
- grid.21729.3f0000000419368729Department of Psychiatry, Radiology and Biomedical Engineering, Columbia University, New York, NY USA
| | - S. Lee
- grid.21729.3f0000000419368729Department of Psychiatry and Biostatistics, New York State Psychiatric Institute/Columbia University, New York, NY USA
| | - T. Perera
- Contemporary Care, Greenwich, CT USA
| | - J. Kangarlu
- grid.411023.50000 0000 9159 4457State University of New York (SUNY) Upstate Medical University, Syracuse, NY USA
| | - T. Palomo
- grid.469673.9Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain ,grid.4795.f0000 0001 2157 7667Department of Psychiatry, Complutense University, Madrid, Spain
| | - M. F. Glasser
- grid.4367.60000 0001 2355 7002Departments of Radiology and Neuroscience, Washington University Medical School, St. Louis, USA
| | - D. C. Javitt
- Division of Experimental Therapeutics, Department of Psychiatry, New York State Psychiatric Institute/Columbia University Medical Center, New York, NY USA
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Klooster DC, Vos IN, Caeyenberghs K, Leemans A, David S, Besseling RM, Aldenkamp AP, Baeken C. Indirect frontocingulate structural connectivity predicts clinical response to accelerated rTMS in major depressive disorder. J Psychiatry Neurosci 2020; 45:243-252. [PMID: 31990490 PMCID: PMC7828925 DOI: 10.1503/jpn.190088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an established treatment for major depressive disorder (MDD), but its clinical efficacy remains rather modest. One reason for this could be that the propagation of rTMS effects via structural connections from the stimulated area to deeper brain structures (such as the cingulate cortices) is suboptimal. METHODS We investigated whether structural connectivity — derived from diffusion MRI data — could serve as a biomarker to predict treatment response. We hypothesized that stronger structural connections between the patient-specific stimulation position in the left dorsolateral prefrontal cortex (dlPFC) and the cingulate cortices would predict better clinical outcomes. We applied accelerated intermittent theta burst stimulation (aiTBS) to the left dlPFC in 40 patients with MDD. We correlated baseline structural connectivity, quantified using various metrics (fractional anisotropy, mean diffusivity, tract density, tract volume and number of tracts), with changes in depression severity scores after aiTBS. RESULTS Exploratory results (p < 0.05) showed that structural connectivity between the patient-specific stimulation site and the caudal and posterior parts of the cingulate cortex had predictive potential for clinical response to aiTBS. LIMITATIONS We used the diffusion tensor to perform tractography. A main limitation was that multiple fibre directions within voxels could not be resolved, which might have led to missing connections in some patients. CONCLUSION Stronger structural frontocingular connections may be of essence to optimally benefit from left dlPFC rTMS treatment in MDD. Even though the results are promising, further investigation with larger numbers of patients, more advanced tractography algorithms and classic daily rTMS treatment paradigms is warranted. CLINICAL TRIAL REGISTRATION http://clinicaltrials.gov/show/NCT01832805
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Affiliation(s)
- Deborah C.W. Klooster
- From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken)
| | - Iris N. Vos
- From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken)
| | - Karen Caeyenberghs
- From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken)
| | - Alexander Leemans
- From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken)
| | - Szabolcs David
- From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken)
| | - René M.H. Besseling
- From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken)
| | - Albert P. Aldenkamp
- From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken)
| | - Chris Baeken
- From the Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, the Netherlands (Klooster, Vos, Besseling, Aldenkamp); the Academic Center for Epileptology Kempenhaeghe, Department of Research and Development, Heeze, the Netherlands (Klooster, Aldenkamp); Ghent University, Ghent Experimental Psychiatry Laboratory, Ghent, Belgium (Baeken); the Australian Catholic University, Faculty of Health Sciences, Mary MacKillop Institute for Health Research, Melbourne, Australia (Caeyenberghs); the PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands (Leemans, David); the Brussel University Hospital, Department of Psychiatry, Brussels, Belgium (Baeken)
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Cambiaghi M, Crupi R, Bautista EL, Elsamadisi A, Malik W, Pozdniakova H, Han Z, Buffelli M, Battaglia F. The Effects of 1-Hz rTMS on Emotional Behavior and Dendritic Complexity of Mature and Newly Generated Dentate Gyrus Neurons in Male Mice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114074. [PMID: 32521613 PMCID: PMC7312937 DOI: 10.3390/ijerph17114074] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022]
Abstract
Low-frequency repetitive transcranial magnetic stimulation (1-Hz rTMS) is a promising noninvasive tool for the treatment of depression. Hippocampal neuronal plasticity is thought to play a pivotal role in the pathophysiology of depressive disorders and the mechanism of action of antidepressant treatments. We investigated the effect of 1-Hz rTMS treatment on hippocampal dentate gyrus structural plasticity and related emotional behaviors modifications. Experimentally, adult male mice received either five days of 1-Hz rTMS or Sham stimulation. After stimulation, the mice underwent a battery of tests for anxiety-like and depression-like behaviors. We also tested the effect of treatment on mature and newly generated granule cell dendritic complexity. Our data showed that 1-Hz rTMS induced structural plasticity in mature granule cells, as evidenced by increased dendritic length and number of intersections. However, the stimulation did not increase the proliferation of the dentate gyrus progenitor cells. On the contrary, the stimulated mice showed increased dendritic complexity of newly generated neurons. Moreover, 1-Hz rTMS resulted in antidepressant-like effects in the tail suspension test, but it did not affect anxiety-like behaviors. Therefore, our results indicate that 1-Hz rTMS modulates dentate gyrus morphological plasticity in mature and newly generated neurons. Furthermore, our data provide some evidence of an association between the antidepressant-like activity of 1-Hz rTMS and structural plasticity in the hippocampus.
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Affiliation(s)
- Marco Cambiaghi
- Department of Neurosciences, Biomedicine and Movement Sciences-University of Verona, 37134 Verona, Italy; (M.C.); (M.B.)
| | - Rosalia Crupi
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98125 Messina, Italy;
| | - Erick Larios Bautista
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ 07110, USA; (E.L.B.); (A.E.); (W.M.); (H.P.); (Z.H.)
| | - Amir Elsamadisi
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ 07110, USA; (E.L.B.); (A.E.); (W.M.); (H.P.); (Z.H.)
| | - Wasib Malik
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ 07110, USA; (E.L.B.); (A.E.); (W.M.); (H.P.); (Z.H.)
| | - Helen Pozdniakova
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ 07110, USA; (E.L.B.); (A.E.); (W.M.); (H.P.); (Z.H.)
| | - Zhiyong Han
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ 07110, USA; (E.L.B.); (A.E.); (W.M.); (H.P.); (Z.H.)
| | - Mario Buffelli
- Department of Neurosciences, Biomedicine and Movement Sciences-University of Verona, 37134 Verona, Italy; (M.C.); (M.B.)
| | - Fortunato Battaglia
- Department of Medical Sciences, Neurology and Psychiatry, Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ 07110, USA; (E.L.B.); (A.E.); (W.M.); (H.P.); (Z.H.)
- Correspondence: ; Tel.: +97-3761-9605
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Hunter AM, Minzenberg MJ, Cook IA, Krantz DE, Levitt JG, Rotstein NM, Chawla SA, Leuchter AF. Concomitant medication use and clinical outcome of repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder. Brain Behav 2019; 9:e01275. [PMID: 30941915 PMCID: PMC6520297 DOI: 10.1002/brb3.1275] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Repetitive Transcranial Magnetic Stimulation (rTMS) is commonly administered to Major Depressive Disorder (MDD) patients taking psychotropic medications, yet the effects on treatment outcomes remain unknown. We explored how concomitant medication use relates to clinical response to a standard course of rTMS. METHODS Medications were tabulated for 181 MDD patients who underwent a six-week rTMS treatment course. All patients received 10 Hz rTMS administered to left dorsolateral prefrontal cortex (DLPFC), with 1 Hz administered to right DLPFC in patients with inadequate response to and/or intolerance of left-sided stimulation. Primary outcomes were change in Inventory of Depressive Symptomatology Self Report (IDS-SR30) total score after 2, 4, and 6 weeks. RESULTS Use of benzodiazepines was associated with less improvement at week 2, whereas use of psychostimulants was associated with greater improvement at week 2 and across 6 weeks. These effects were significant controlling for baseline variables including age, overall symptom severity, and severity of anxiety symptoms. Response rates at week 6 were lower in benzodiazepine users versus non-users (16.4% vs. 35.5%, p = 0.008), and higher in psychostimulant users versus non-users (39.2% vs. 22.0%, p = 0.02). CONCLUSIONS Concomitant medication use may impact rTMS treatment outcome. While the differences reported here could be considered clinically significant, results were not corrected for multiple comparisons and findings should be replicated before clinicians incorporate the evidence into clinical practice. Prospective, hypothesis-based treatment studies will aid in determining causal relationships between medication treatments and outcome.
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Affiliation(s)
- Aimee M Hunter
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California.,Laboratory of Brain, Behavior, and Pharmacology and the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Michael J Minzenberg
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California.,Laboratory of Brain, Behavior, and Pharmacology and the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Ian A Cook
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California.,Laboratory of Brain, Behavior, and Pharmacology and the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California.,Department of Bioengineering, University of California Los Angeles, Los Angeles, California
| | - David E Krantz
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California.,Laboratory of Brain, Behavior, and Pharmacology and the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Jennifer G Levitt
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California.,Laboratory of Brain, Behavior, and Pharmacology and the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Natalie M Rotstein
- Laboratory of Brain, Behavior, and Pharmacology and the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Shweta A Chawla
- Laboratory of Brain, Behavior, and Pharmacology and the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
| | - Andrew F Leuchter
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California.,Laboratory of Brain, Behavior, and Pharmacology and the TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California
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31
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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] [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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Kaster TS, Downar J, Vila-Rodriguez F, Thorpe KE, Feffer K, Noda Y, Giacobbe P, Knyahnytska Y, Kennedy SH, Lam RW, Daskalakis ZJ, Blumberger DM. Trajectories of Response to Dorsolateral Prefrontal rTMS in Major Depression: A THREE-D Study. Am J Psychiatry 2019; 176:367-375. [PMID: 30764649 DOI: 10.1176/appi.ajp.2018.18091096] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for refractory major depressive disorder, yet no studies have characterized trajectories of rTMS response. The aim of this study was to characterize response trajectories for patients with major depression undergoing left dorsolateral prefrontal cortex rTMS and to determine associated baseline clinical characteristics. METHODS This was a secondary analysis of a randomized noninferiority trial (N=388) comparing conventional 10-Hz rTMS and intermittent theta burst stimulation (iTBS) rTMS. Participants were adult outpatients who had a primary diagnosis of major depressive disorder, had a score ≥18 on the 17-item Hamilton Depression Rating Scale (HAM-D), and did not respond to one to three adequate antidepressant trials. Treatment was either conventional 10-Hz rTMS or iTBS rTMS applied to the dorsolateral prefrontal cortex, 5 days/week over 4-6 weeks (20-30 sessions). Group-based trajectory modeling was applied to identify HAM-D response trajectories, and regression techniques were used to identify associated characteristics. RESULTS Four trajectories were identified: nonresponse (N=43, 11%); rapid response (N=73, 19%); higher baseline symptoms, linear response (N=118, 30%); and lower baseline symptoms, linear response (N=154, 40%). Significant differences in response and remission rates between trajectories were detectable by week 1. There was no association between treatment protocol and response trajectory. Higher baseline scores on the HAM-D and the Quick Inventory of Depression Symptomatology-Self-Report (QIDS-SR) were associated with the nonresponse trajectory, and older age, lower QIDS-SR score, and lack of benzodiazepine use were associated with the rapid response trajectory. CONCLUSIONS Major depression shows distinct response trajectories to rTMS, which are associated with baseline clinical characteristics but not treatment protocol. These response trajectories with differential response to rTMS raise the possibility of developing individualized treatment protocols.
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Affiliation(s)
- Tyler S Kaster
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Jonathan Downar
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Fidel Vila-Rodriguez
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Kevin E Thorpe
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Kfir Feffer
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Yoshihiro Noda
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Peter Giacobbe
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Yuliya Knyahnytska
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Sidney H Kennedy
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Raymond W Lam
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Zafiris J Daskalakis
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
| | - Daniel M Blumberger
- The Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto (Kaster, Knyahnytska, Daskalakis, Blumberger); the Department of Psychiatry (Kaster, Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), the Institute of Medical Science (Downar, Giacobbe, Kennedy, Daskalakis, Blumberger), and the Dalla Lana School of Public Health (Thorpe), University of Toronto, Toronto; the MRI-Guided rTMS Clinic, Toronto Western Hospital, Toronto (Downar); the Krembil Research Institute, University Health Network, Toronto (Downar, Kennedy); the Department of Psychiatry, University of British Columbia, Vancouver (Vila-Rodriguez, Lam); the Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver (Vila-Rodriguez); the Shalvata Mental Health Center, Hod-Hasharon, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv (Feffer); the Department of Neuropsychiatry, School of Medicine, Keio University, Tokyo (Noda); the Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto (Giacobbe); and the Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto (Kennedy)
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Latorre A, Rocchi L, Berardelli A, Bhatia KP, Rothwell JC. The use of transcranial magnetic stimulation as a treatment for movement disorders: A critical review. Mov Disord 2019; 34:769-782. [PMID: 31034682 DOI: 10.1002/mds.27705] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Transcranial magnetic stimulation is a safe and painless non-invasive brain stimulation technique that has been largely used in the past 30 years to explore cortical function in healthy participants and, inter alia, the pathophysiology of movement disorders. During the years, its use has evolved from primarily research purposes to treatment of a large variety of neurological and psychiatric diseases. In this article, we illustrate the basic principles on which the therapeutic use of transcranial magnetic stimulation is based and review the clinical trials that have been performed in patients with movement disorders. METHODS A search of the PubMed database for research and review articles was performed on therapeutic applications of transcranial magnetic stimulation in movement disorders. The search included the following conditions: Parkinson's disease, dystonia, Tourette syndrome and other chronic tic disorders, Huntington's disease and choreas, and essential tremor. The results of the studies and possible mechanistic explanations for the relatively minor effects of transcranial magnetic stimulation are discussed. Possible ways to improve the methodology and achieve greater therapeutic efficacy are discussed. CONCLUSION Despite the promising and robust rationales for the use of transcranial magnetic stimulations as a treatment tool in movement disorders, the results taken as a whole are not as successful as were initially expected. There is encouraging evidence that transcranial magnetic stimulation may improve motor symptoms and depression in Parkinson's disease, but the efficacy in other movement disorders is unclear. Possible improvements in methodology are on the horizon but have yet to be implemented in large clinical studies. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, Isernia, Italy
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology University College London, London, UK
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Cristancho P, Trapp NT, Siddiqi SH, Dixon D, Miller JP, Lenze EJ. Crossover to Bilateral Repetitive Transcranial Magnetic Stimulation: A Potential Strategy When Patients Are Not Responding to Unilateral Left-Sided High-Frequency Repetitive Transcranial Magnetic Stimulation. J ECT 2019; 35:3-5. [PMID: 29877963 PMCID: PMC6281787 DOI: 10.1097/yct.0000000000000500] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Clinical trials using left-sided repetitive transcranial magnetic stimulation (rTMS) report remission rates of 14% to 32.6%. A large percentage of patients would not achieve remission with standard rTMS treatment. The question of what clinicians should do when a patient is not responding to standard high-frequency (HF) left-sided rTMS remains unanswered. This prospective case series examines whether crossover to bilateral stimulation enhances antidepressant outcomes in patients not responding to unilateral rTMS. Patients in a major depressive episode received an rTMS clinical protocol of 4 to 6 weeks' duration. Stimulation began with HF rTMS (10 Hz) over the left dorsolateral prefrontal cortex (range, 3000-5000 pulses per session). A total of 17 patients without sufficient clinical improvement early in their rTMS course received 1-Hz rTMS (range, 600-1200 pps) over the right dorsolateral prefrontal cortex (added to the HF left-sided stimulation). Hamilton Depression Rating Scale scores decreased from 13.9 ± 3.9 (mean ± SD) from the start of augmentation to 12.2 ± 5.8 at the end of acute treatment, a 1.7-point change, Cohen d effect size = -0.35, 95% confidence interval, -1.01 to - 0.34, suggesting improvement. Remission rate in this sample was 24% (4/17). This case series indicates that crossover to bilateral stimulation is a feasible and potentially effective strategy when patients are not improving with standard rTMS. A randomized controlled trial comparing crossover versus standard rTMS is needed to determine the efficacy of this paradigm.
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Affiliation(s)
| | | | | | | | - J Philip Miller
- Division of Biostatistics, School of Medicine, Washington University in St Louis, St Louis, MO
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Shalbaf R, Brenner C, Pang C, Blumberger DM, Downar J, Daskalakis ZJ, Tham J, Lam RW, Farzan F, Vila-Rodriguez F. Non-linear Entropy Analysis in EEG to Predict Treatment Response to Repetitive Transcranial Magnetic Stimulation in Depression. Front Pharmacol 2018; 9:1188. [PMID: 30425640 PMCID: PMC6218964 DOI: 10.3389/fphar.2018.01188] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Biomarkers that predict clinical outcomes in depression are essential for increasing the precision of treatments and clinical outcomes. The electroencephalogram (EEG) is a non-invasive neurophysiological test that has promise as a biomarker sensitive to treatment effects. The aim of our study was to investigate a novel non-linear index of resting state EEG activity as a predictor of clinical outcome, and compare its predictive capacity to traditional frequency-based indices. Methods: EEG was recorded from 62 patients with treatment resistant depression (TRD) and 25 healthy comparison (HC) subjects. TRD patients were treated with excitatory repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) for 4 to 6 weeks. EEG signals were first decomposed using the empirical mode decomposition (EMD) method into band-limited intrinsic mode functions (IMFs). Subsequently, Permutation Entropy (PE) was computed from the obtained second IMF to yield an index named PEIMF2. Receiver Operator Characteristic (ROC) curve analysis and ANOVA test were used to evaluate the efficiency of this index (PEIMF2) and were compared to frequency-band based methods. Results: Responders (RP) to rTMS exhibited an increase in the PEIMF2 index compared to non-responders (NR) at F3, FCz and FC3 sites (p < 0.01). The area under the curve (AUC) for ROC analysis was 0.8 for PEIMF2 index for the FC3 electrode. The PEIMF2 index was superior to ordinary frequency band measures. Conclusion: Our data show that the PEIMF2 index, yields superior outcome prediction performance compared to traditional frequency band indices. Our findings warrant further investigation of EEG-based biomarkers in depression; specifically entropy indices applied in band-limited EEG components. Registration in ClinicalTrials.Gov; identifiers NCT02800226 and NCT01887782.
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Affiliation(s)
- Reza Shalbaf
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Colleen Brenner
- Department of Psychology, Loma Linda University, Loma Linda, CA, United States
| | - Christopher Pang
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,MRI-Guided rTMS Clinic and Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Joseph Tham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, BC, Canada
| | - Fidel Vila-Rodriguez
- Non-Invasive Neurostimulation Therapies (NINET) Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Garnaat SL, Yuan S, Wang H, Philip NS, Carpenter LL. Updates on Transcranial Magnetic Stimulation Therapy for Major Depressive Disorder. Psychiatr Clin North Am 2018; 41:419-431. [PMID: 30098655 PMCID: PMC6979370 DOI: 10.1016/j.psc.2018.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Transcranial magnetic stimulation has emerged as a treatment option for treatment-resistant depression. While existing data largely support efficacy of transcranial magnetic stimulation for major depressive disorder, ongoing research aims to optimize treatment parameters and identify biomarkers of treatment response. In this article, the authors describe data from controlled trials and ongoing efforts to enhance transcranial magnetic stimulation outcomes for major depressive disorder. Findings from preliminary research aimed at identifying neuroimaging and neurophysiological biomarkers of transcranial magnetic stimulation effects are discussed.
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Affiliation(s)
- Sarah L. Garnaat
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Butler Hospital, Providence, RI, USA
| | - Shiwen Yuan
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Haizhi Wang
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Noah S. Philip
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Butler Hospital, Providence, RI, USA,Providence VA Medical Center, Providence, RI, USA
| | - Linda L. Carpenter
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA,Butler Hospital, Providence, RI, USA
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Modirrousta M, Meek BP, Wikstrom SL. Efficacy of twice-daily vs once-daily sessions of repetitive transcranial magnetic stimulation in the treatment of major depressive disorder: a retrospective study. Neuropsychiatr Dis Treat 2018; 14:309-316. [PMID: 29398915 PMCID: PMC5775741 DOI: 10.2147/ndt.s151841] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE There is no clinical consensus on the optimal protocol for the treatment of major depressive disorder (MDD) using repetitive transcranial magnetic stimulation (rTMS). Accelerated protocols using more than a single session of treatment per day have been suggested as a means to reduce the overall length of time required for rTMS therapy. The objective of this study is to compare the treatment outcomes of patients with MDD who received two sessions of rTMS per day vs those who received one session per day, keeping the overall number of delivered pulses constant. PATIENTS AND METHODS In a retrospective study, we compared treatment outcomes of 36 patients with MDD who received 30 sessions of high-frequency (10 Hz) rTMS over the left dorsolateral prefrontal cortex. Patients received 3,000 pulses per session (5 s trains, 25 s intertrain interval) at 110% of resting motor threshold using a figure-eight coil. Patients received either two rTMS sessions per day (n=17) or one session per day (n=19). Depression symptoms were assessed by a psychiatrist using the Hamilton Rating Scale for Depression at baseline and after every 10 sessions of rTMS. RESULTS The majority of patients in both groups responded to treatment, and there was a trend toward greater response rate in the twice-daily (TD) group (82.4%) compared to the once-daily (OD) group (52.6%). TD stimulation was tolerable for patients and produced no adverse side effects. Patients in the TD group experienced an improvement in symptoms faster than the OD group due to the accelerated therapy period. CONCLUSION Administration of two rTMS treatment sessions per day is tolerable for patients and does not seem to be inferior in efficacy to a OD protocol. TD administration has the benefit of producing symptom improvement over a shorter time span and requires fewer visits to the clinic.
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Affiliation(s)
- Mandana Modirrousta
- Department of Psychiatry, University of Manitoba
- Mental Health, Saint Boniface General Hospital, Winnipeg, MB, Canada
| | - Benjamin P Meek
- Mental Health, Saint Boniface General Hospital, Winnipeg, MB, Canada
| | - Sara L Wikstrom
- Mental Health, Saint Boniface General Hospital, Winnipeg, MB, Canada
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McClintock SM, Reti IM, Carpenter LL, McDonald WM, Dubin M, Taylor SF, Cook IA, O’Reardon J, Husain MM, Wall C, Krystal AD, Sampson SM, Morales O, Nelson BG, Latoussakis V, George MS, Lisanby SH. Consensus Recommendations for the Clinical Application of Repetitive Transcranial Magnetic Stimulation (rTMS) in the Treatment of Depression. J Clin Psychiatry 2018; 79:16cs10905. [PMID: 28541649 PMCID: PMC5846193 DOI: 10.4088/jcp.16cs10905] [Citation(s) in RCA: 313] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/20/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To provide expert recommendations for the safe and effective application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder (MDD). PARTICIPANTS Participants included a group of 17 expert clinicians and researchers with expertise in the clinical application of rTMS, representing both the National Network of Depression Centers (NNDC) rTMS Task Group and the American Psychiatric Association Council on Research (APA CoR) Task Force on Novel Biomarkers and Treatments. EVIDENCE The consensus statement is based on a review of extensive literature from 2 databases (OvidSP MEDLINE and PsycINFO) searched from 1990 through 2016. The search terms included variants of major depressive disorder and transcranial magnetic stimulation. The results were limited to articles written in English that focused on adult populations. Of the approximately 1,500 retrieved studies, a total of 118 publications were included in the consensus statement and were supplemented with expert opinion to achieve consensus recommendations on key issues surrounding the administration of rTMS for MDD in clinical practice settings. CONSENSUS PROCESS In cases in which the research evidence was equivocal or unclear, a consensus decision on how rTMS should be administered was reached by the authors of this article and is denoted in the article as "expert opinion." CONCLUSIONS Multiple randomized controlled trials and published literature have supported the safety and efficacy of rTMS antidepressant therapy. These consensus recommendations, developed by the NNDC rTMS Task Group and APA CoR Task Force on Novel Biomarkers and Treatments, provide comprehensive information for the safe and effective clinical application of rTMS in the treatment of MDD.
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Affiliation(s)
- Shawn M. McClintock
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Corresponding author: Shawn M. McClintock, PhD, Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8898 ()
| | - Irving M. Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Linda L. Carpenter
- Butler Hospital, Brown Department of Psychiatry and Human Behavior, Providence, Rhode Island
| | - William M. McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Marc Dubin
- Department of Psychiatry, Weill Cornell Medical College, White Plains, New York
| | | | - Ian A. Cook
- Semel Institute for Neuroscience and Human Behavior, Departments of Psychiatry and Behavioral Sciences and of Bioengineering, University of California at Los Angeles, Los Angeles
| | - John O’Reardon
- Department of Psychiatry and Behavioral Sciences, Rowan University School of Medicine, Stratford, New Jersey
| | - Mustafa M. Husain
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas,Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Andrew D. Krystal
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco
| | | | - Oscar Morales
- Psychiatric Neurotherapeutics Program, McLean Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brent G. Nelson
- Department of Psychiatry, University of Minnesota, St Louis Park
| | | | - Mark S. George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston,Ralph H. Johnson VA Medical Center, Charleston, South Carolina
| | - Sarah H. Lisanby
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
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Feffer K, Fettes P, Giacobbe P, Daskalakis ZJ, Blumberger DM, Downar J. 1Hz rTMS of the right orbitofrontal cortex for major depression: Safety, tolerability and clinical outcomes. Eur Neuropsychopharmacol 2018; 28:109-117. [PMID: 29153927 DOI: 10.1016/j.euroneuro.2017.11.011] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/12/2017] [Accepted: 11/04/2017] [Indexed: 12/28/2022]
Abstract
Conventional rTMS in major depressive disorder (MDD) targets the dorsolateral prefrontal cortex (DLPFC). However, many patients do not respond to DLPFC-rTMS. Recent evidence suggests that the right lateral orbitofrontal cortex (OFC) plays a key role in 'non-reward' functions and shows hyperconnectivity in MDD. OFC-rTMS has been used successfully in obsessive-compulsive disorder, and achieved remission in an MDD case nonresponsive to DLPFC- and DMPFC-rTMS. Here, we assess the safety and tolerability of right OFC-rTMS, and examine the effectiveness of inhibitory right OFC-rTMS in MDD, particularly among patients with previous nonresponse to DMPFC-rTMS. We performed a chart review to retrieve data on clinical characteristics, stimulation parameters, adverse events, and clinical symptom outcomes for a series of 42 patients with medication-resistant and/or DMPFC-rTMS-nonresponsive MDD, who underwent 20-30 sessions of 1Hz right OFC-rTMS at a single Canadian clinic from 2015 to 2017. Over 882 sessions of treatment, there were no seizures, visual/ocular complications, or other serious or treatment-limiting adverse events. Pain ratings averaged 6-7/10 (10=maximum tolerable); no patient discontinued treatment prematurely due to pain. 15/42 patients (35.7%) achieved response (≥50% symptom reduction) and 10/42 (23.8%) achieved remission. Among the 30/42 patients who were previous nonresponders to DMPFC-rTMS, 9/30 (30.0%) achieved response and 7/30 (23.8%) achieved remission. Response distribution was sharply bimodal. 1Hz right OFC-rTMS appears safe and tolerable, and may achieve remission in MDD patients even when conventional rTMS has failed. Sham-controlled follow-up studies may be warranted.
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Affiliation(s)
- Kfir Feffer
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Shalvata Mental Health Center, Hod-Hasharon, Israel
| | - Peter Fettes
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Peter Giacobbe
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada
| | - Jonathan Downar
- MRI-Guided rTMS Clinic, University Health Network, Toronto, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada.
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40
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Early symptom improvement at 10 sessions as a predictor of rTMS treatment outcome in major depression. Brain Stimul 2018; 11:181-189. [DOI: 10.1016/j.brs.2017.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/27/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022] Open
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41
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Tavares DF, Myczkowski ML, Alberto RL, Valiengo L, Rios RM, Gordon P, de Sampaio-Junior B, Klein I, Mansur CG, Marcolin MA, Lafer B, Moreno RA, Gattaz W, Daskalakis ZJ, Brunoni AR. Treatment of Bipolar Depression with Deep TMS: Results from a Double-Blind, Randomized, Parallel Group, Sham-Controlled Clinical Trial. Neuropsychopharmacology 2017; 42:2593-2601. [PMID: 28145409 PMCID: PMC5686495 DOI: 10.1038/npp.2017.26] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/19/2017] [Accepted: 01/27/2017] [Indexed: 12/26/2022]
Abstract
Bipolar depression (BD) is a highly prevalent condition with limited therapeutic options. Deep (H1-coil) transcranial magnetic stimulation (dTMS) is a novel TMS modality with established efficacy for unipolar depression. We conducted a randomized sham-controlled trial to evaluate the efficacy and safety of dTMS in treatment-resistant BD patients. Patients received 20 sessions of active or sham dTMS over the left dorsolateral prefrontal cortex (H1-coil, 55 18 Hz 2 s 120% MT trains). The primary outcome was changes in the 17-item Hamilton Depression Rating Scale (HDRS-17) from baseline to endpoint (week 4). Secondary outcomes were changes from baseline to the end of the follow-up phase (week 8), and response and remission rates. Safety was assessed using a dTMS adverse effects questionnaire and the Young Mania Rating Scale to assess treatment-emergent mania switch (TEMS). Out of 50 patients, 43 finished the trial. There were 2 and 5 dropouts in the sham and active groups, respectively. Active dTMS was superior to sham at end point (difference favoring dTMS=4.88; 95% CI 0.43 to 9.32, p=0.03) but not at follow-up. There was also a trend for greater response rates in the active (48%) vs sham (24%) groups (OR=2.92; 95% CI=0.87 to 9.78, p=0.08). Remission rates were not statistically different. No TEMS episodes were observed. Deep TMS is a potentially effective and well-tolerated add-on therapy in resistant bipolar depressed patients receiving adequate pharmacotherapy.
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Affiliation(s)
- Diego F Tavares
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Martin L Myczkowski
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Rodrigo L Alberto
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Leandro Valiengo
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Rosa M Rios
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pedro Gordon
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Bernardo de Sampaio-Junior
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
| | - Izio Klein
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
| | - Carlos G Mansur
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marco Antonio Marcolin
- Department and Institute of Neurology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Beny Lafer
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ricardo A Moreno
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Wagner Gattaz
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Zafiris J Daskalakis
- Centre for Addiction and Mental Health, Clarke Division, Toronto, Ontario, Canada
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN-EMT), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Laboratory of Neuroscience (LIM27), Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
- University Hospital, University of São Paulo, São Paulo, Brazil
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42
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Two Versus One High-Frequency Repetitive Transcranial Magnetic Stimulation Session per Day for Treatment-Resistant Depression: A Randomized Sham-Controlled Trial. J ECT 2017; 33:190-197. [PMID: 28072660 DOI: 10.1097/yct.0000000000000387] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) has proven antidepressant effects, but the optimal frequency of sessions remains unclear. METHODS We conducted a 3-week, sham-controlled trial to assess the antidepressant efficacy of 1 active HF-rTMS session per day (A1 group) compared with 2 per day (A2 group) and equivalent sham sessions (once a day, S1 group; twice a day, S2 group) in patients with treatment-resistant major depression with a subsequent 2-week follow-up period. One hundred seventy-seven patients were screened, of whom 105 met eligibility criteria and 98 consented and were randomized. The HF-rTMS (20 Hz) was targeted to the left prefrontal cortex in sessions of approximately 40 trains (2 seconds each) at 100% resting motor threshold with an intertrain interval of 1 minute. Treatment response was defined as a 50% or greater decrease in the Hamilton Depression Rating Scale (HDRS) score and/or Clinician Global Impressions-Severity of Illness (CGI-S) score of 3 or less. Remission was defined as HDRS score less than 8 and/or CGI-S score of 2 or less. RESULTS Practically none of the subjects in either sham groups achieved remission. Increased odds of remission were present for CGI-S by stimulating twice rather than once per day (odds ratio [OR] = 1.5, P = 0.018), whereas there was a marginal result for HDRS (OR = 3.9, P = 0.066). Patients who had lower baseline HDRS (OR = 0.75, P = 0.014) and CGI-S scores (OR = 0.18, P = 0.001) were more likely to achieve remission. CONCLUSIONS Twice per day active HF-rTMS might be more effective than once per day active HF-rTMS or sham stimulation.
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Sahlem GL, Baker NL, George MS, Malcolm RJ, McRae-Clark AL. Repetitive transcranial magnetic stimulation (rTMS) administration to heavy cannabis users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:47-55. [PMID: 28806104 PMCID: PMC5962012 DOI: 10.1080/00952990.2017.1355920] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cannabis use disorder (CUD) is a common condition with few treatments. Several studies in other substance use disorders have found that applying repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) decreases cue-elicited craving and possibly decreases use. To date, there have been no studies attempting to use rTMS in CUD. OBJECTIVES This study was conducted to determine if rTMS could be feasibly delivered to a group of non-treatment seeking CUD participants. Secondarily, the study aimed to estimate the effect of rTMS on craving. METHODS In a double-blind, sham-controlled, crossover design, a single session of active or sham rTMS (Left DLPFC, 10 Hz, 110% rMT, 4000 pulses) was delivered during a validated cannabis cue paradigm. Participants crossed over to complete the other condition one week later. The feasibility and tolerability were measured by the rate of retention, and the percentage of participants able to tolerate full dose rTMS, respectively. Craving was measured using the Marijuana Craving Questionnaire (MCQ). RESULTS Eighteen non-treatment seeking CUD participants were recruited from the community; 16 (three women) completed the trial (89% retained for the three study visits). All of the treatment completers tolerated rTMS at full dose without adverse effects. There was not a significant reduction in the total MCQ when participants received active rTMS as compared to sham rTMS. CONCLUSION rTMS can be safely and feasibly delivered to CUD participants, and treatment is well tolerated. A single session of rTMS applied to the DLPFC may not reduce cue-elicited craving in heavy cannabis users.
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Affiliation(s)
- Gregory L. Sahlem
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
- Department of Psychiatry, Ralph H. Johnson Veterans Administration Hospital, Charleston, SC, USA
| | - Robert J. Malcolm
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - Aimee L. McRae-Clark
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
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James GA, Thostenson JD, Brown G, Carter G, Hayes H, Tripathi SP, Dobry DJ, Govindan RB, Dornhoffer JL, Williams DK, Kilts CD, Mennemeier MS. Neural activity during attentional conflict predicts reduction in tinnitus perception following rTMS. Brain Stimul 2017. [PMID: 28629874 DOI: 10.1016/j.brs.2017.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Subjective idiopathic tinnitus is an intrusive, distracting, and potentially disabling disorder characterized by phantom perception of sounds. Although tinnitus has no approved pharmacologic treatment, recent evidence supports the use of repetitive transcranial magnetic stimulation (rTMS) to alleviate tinnitus symptoms. OBJECTIVE/HYPOTHESIS Repetitive TMS delivered over the middle superior temporal gyrus (STG) may alter ratings of tinnitus awareness and annoyance more than loudness due to change in attentional processing. STG has reciprocal connections to regions of the prefrontal cortex that mediate attention. To probe the hypothesized influence of STG stimulation on attention, a subset of patients with tinnitus enrolled in an rTMS clinical trial [n = 12, 9 male, mean (sd) age = 49 (15) years] underwent an attentional conflict task before and after rTMS treatment in a repeated-measures functional magnetic resonance imaging (fMRI) study. METHODS The Multi-Source Interference Task (MSIT), a Stroop-based visual attentional conflict fMRI task, was used to map participants' neural processing of attentional conflict prior to rTMS intervention (Baseline) and after three rTMS intervention arms: Sham, 1 Hz, and 10 Hz (four sessions per arm, 1800 pulses per session, delivered @110% of the motor threshold over the posterior superior temporal gyrus). RESULTS All measures of tinnitus severity (awareness, loudness, and annoyance) improved with 1 Hz rTMS intervention; however, the greatest and most robust changes were observed for ratings of tinnitus awareness (mean 16% reduction in severity from Baseline, p < 0.01). The MSIT elicited a similar pattern of neural activation among tinnitus participants at Baseline compared to an independent sample of 43 healthy comparison adults (r = 0.801, p = 0.001). Linear regression with bootstrap resampling showed that greater recruitment of bilateral prefrontal and bilateral parietal regions by MSIT at Baseline corresponded with poorer treatment response. Individual regions' activities explained 37-67% variance in participant treatment response, with left dorsolateral prefrontal cortex's MSIT activity at Baseline explaining the greatest reduction in tinnitus awareness following 1 Hz stimulation. Although left dorsolateral prefrontal cortex activity at Baseline also predicted reduction in tinnitus loudness and annoyance (∼50% variance explained), these symptoms were more strongly predicted by right middle occipital cortex (∼70% variance explained) - suggesting that the neural predictors of symptom-specific treatment outcomes may be dissociable. CONCLUSION These candidate neural reactivity markers of treatment response have potential clinical value in identifying tinnitus sufferers who would or would not therapeutically benefit from rTMS intervention.
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Affiliation(s)
- G A James
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States.
| | - J D Thostenson
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - G Brown
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - G Carter
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - H Hayes
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - S P Tripathi
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - D J Dobry
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - R B Govindan
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - J L Dornhoffer
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - D K Williams
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - C D Kilts
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
| | - M S Mennemeier
- University of Arkansas for Medical Sciences, 4301 W. Markham St #554, Little Rock, AR 72205-7199, United States
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Durmaz O, Ebrinc S, Ates MA, Algul A. Evaluation of repetitive transcranial magnetic stimulation for treatment-resistant major depression and the impact of anxiety symptoms on outcome. PSYCHIAT CLIN PSYCH 2017. [DOI: 10.1080/24750573.2017.1293239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Yip AG, George MS, Tendler A, Roth Y, Zangen A, Carpenter LL. 61% of unmedicated treatment resistant depression patients who did not respond to acute TMS treatment responded after four weeks of twice weekly deep TMS in the Brainsway pivotal trial. Brain Stimul 2017; 10:847-849. [PMID: 28330592 DOI: 10.1016/j.brs.2017.02.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 01/22/2017] [Accepted: 02/25/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND An acute course of dTMS typically involves treatments delivered 5 days a week, for 4 weeks. Should more treatments be given if the patient has not responded? Data are needed to inform decisions about the best next steps for acute non-responders. OBJECTIVE To characterize response among acute-phase non-responders in a randomized controlled trial of deep repetitive transcranial magnetic stimulation (dTMS) monotherapy for medication-resistant depression. METHODS Summary statistics and Kaplan-Meier curves were used to characterize outcomes of 33 medication-free Brainsway™ dTMS non-responders to double blind but active treatment at the end of 4 weeks (20 sessions), who then continued double blind but active twice-weekly treatment for up to 12 additional weeks. RESULTS 24 participants (72.7%) achieved responder status during at least one rating with dTMS continuation -- 20 (60.6%) within four weeks, with 13 (39.4%) consistently meeting response criteria for the duration of the study. 20 (63.6%) achieved remission status at some point during treatment continuation. CONCLUSIONS A significant proportion of acute course non-responders to dTMS treatment eventually respond with continued treatment. Continuing TMS treatment beyond the acute course for non-responders may result in eventual response in over half of these individuals.
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Affiliation(s)
- Agustin G Yip
- Butler Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States.
| | - Mark S George
- Ralph H Johnson VA Medical Center, Charleston, SC, United States; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | | | | | - Abraham Zangen
- The Zlotoesky Neuroscience Center, Ben-Gurion University, Beer Shava, Israel
| | - Linda L Carpenter
- Butler Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States
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Taylor SF, Bhati MT, Dubin MJ, Hawkins JM, Lisanby SH, Morales O, Reti IM, Sampson S, Short EB, Spino C, Watcharotone K, Wright J. A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression. J Affect Disord 2017; 208:284-290. [PMID: 27794252 PMCID: PMC5550826 DOI: 10.1016/j.jad.2016.08.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/21/2016] [Accepted: 08/24/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) was approved in 2008 in the United States, and there are relatively few studies describing its use in regular clinical practice since approval. METHODS From April 2011 to October 2014, ten sites within the National Network of Depression Centers (NNDC) provided data on 62 evaluable patients with a depressive episode. Treatment was determined naturalistically. Response was assessed by the Quick Inventory of Depressive Symptoms, Self-Report (QIDS-SR) as the primary outcome, and the Patient Health Questionnaire-9 (PHQ-9) and the clinician-rated Clinical Global Impression (CGI) as secondary depression measures. RESULTS Enrolled patients exhibited significant treatment resistance, with 70.2% reporting more than 4 prior depressive episodes. Most patients received treatment with standard parameters (10Hz over the left dorsolateral prefrontal cortex), although 22.6% of the patients received 1 or 5Hz stimulation at some point. Over 6 weeks of treatment, response and remission rates were 29.4% and 5.9%, respectively, for the QIDS-SR; 39.2% and 15.7%, respectively, for the PHQ-9; and 50.9% and 17.9%, respectively, for the CGI. Moderator analyses revealed no effect of prior depressive episodes, history of ECT or gender, although early life stress predicted a better response to rTMS therapy. LIMITATIONS The study was an open-label, registry trial, with relatively coarse clinical data, reflecting practice only in academic, depression-specialty centers. Because of the relatively small size and heterogeneity of the sample, type 2 errors are possible and positive findings are in need of replication. CONCLUSION rTMS demonstrates effectiveness in clinical practice within the NNDC, although remission rates appear slightly lower in comparison with other recent naturalistic studies.
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Affiliation(s)
- Stephan F. Taylor
- University of Michigan, Ann Arbor, Michigan,To whom correspondence should be addressed: Department of Psychiatry, Rachel Upjohn Building 4250 Plymouth Rd, Ann Arbor MI 48109-2700, Phone: (734) 936-4955, Fax: (734) 936-7868,
| | | | | | | | - Sarah H. Lisanby
- Duke University, Durham, North Carolina and National Institute of Mental Health
| | - Oscar Morales
- McLean Hospital, Harvard University, Cambridge, Massachusetts
| | | | | | - E. Baron Short
- Medical University of South Carolina, Charleston, South Carolina
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McDonald WM. Neuromodulation Treatments for Geriatric Mood and Cognitive Disorders. Am J Geriatr Psychiatry 2016; 24:1130-1141. [PMID: 27889282 DOI: 10.1016/j.jagp.2016.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 01/05/2023]
Abstract
There is increasing evidence for the efficacy of neuromodulation in the treatment of resistant mood disorders and emerging data supporting the use of neuromodulation in cognitive disorders. A significant minority of depressed elders do not respond to pharmacotherapy and/or psychotherapy. This has led clinicians to recommend the increasing use of electroconvulsive therapy (ECT) in the treatment of medication-resistant or life-threatening geriatric depression. Multiple studies have supported the safety and efficacy of ECT in the elderly, yet ECT is associated with side effects including cardiovascular and cognitive side effects. Neuromodulation therapies have the potential for providing effective treatment for treatment-resistant older adults with reduced side effects and this review will outline the risks and benefits of neuromodulation treatment in geriatric psychiatry. There is also emerging evidence of the efficacy of neuromodulation devices in the treatment of cognitive disorders. Pharmacotherapy has been largely ineffective in changing the course of neurodegenerative diseases causing dementia and other treatments are clearly needed. This review will outline the available evidence for neuromodulation in the treatment of mood and cognitive disorders in the elderly.
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Affiliation(s)
- William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
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Gay A, Jaussent I, Sigaud T, Billard S, Attal J, Seneque M, Galusca B, Van Den Eynde F, Massoubre C, Courtet P, Guillaume S. A Lack of Clinical Effect of High-frequency rTMS to Dorsolateral Prefrontal Cortex on Bulimic Symptoms: A Randomised, Double-blind Trial. EUROPEAN EATING DISORDERS REVIEW 2016; 24:474-481. [DOI: 10.1002/erv.2475] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/12/2016] [Accepted: 08/11/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Aurelia Gay
- University Department of Psychiatry and Addictology, North Hospital; CHU St-Etienne; St Etienne France
- TAPE Laboratory, EA7423; Jean Monnet University; Saint Etienne France
| | | | - Torrance Sigaud
- University Department of Psychiatry and Addictology, North Hospital; CHU St-Etienne; St Etienne France
- TAPE Laboratory, EA7423; Jean Monnet University; Saint Etienne France
| | - Stephane Billard
- University Department of Psychiatry and Addictology, North Hospital; CHU St-Etienne; St Etienne France
| | - Jerome Attal
- Inserm U1061; University of Montpellier; Montpellier France
- University Department of Adult Psychiatry; CHRU Montpellier; Montpellier France
| | - Maude Seneque
- Inserm U1061; University of Montpellier; Montpellier France
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital; CHRU Montpellier; Montpellier France
| | - Bogdan Galusca
- TAPE Laboratory, EA7423; Jean Monnet University; Saint Etienne France
| | - Frederique Van Den Eynde
- Eating Disorders Program, Department of Psychiatry, Douglas Hospital; McGill University; Montreal Canada
| | - Catherine Massoubre
- University Department of Psychiatry and Addictology, North Hospital; CHU St-Etienne; St Etienne France
- TAPE Laboratory, EA7423; Jean Monnet University; Saint Etienne France
| | - Philippe Courtet
- Inserm U1061; University of Montpellier; Montpellier France
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital; CHRU Montpellier; Montpellier France
| | - Sebastien Guillaume
- Inserm U1061; University of Montpellier; Montpellier France
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital; CHRU Montpellier; Montpellier France
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Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ, Downar J, Modirrousta M, Patry S, Vila-Rodriguez F, Lam RW, MacQueen GM, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 4. Neurostimulation Treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:561-75. [PMID: 27486154 PMCID: PMC4994792 DOI: 10.1177/0706743716660033] [Citation(s) in RCA: 350] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Neurostimulation Treatments" is the fourth of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 31 questions for 6 neurostimulation modalities: 1) transcranial direct current stimulation (tDCS), 2) repetitive transcranial magnetic stimulation (rTMS), 3) electroconvulsive therapy (ECT), 4) magnetic seizure therapy (MST), 5) vagus nerve stimulation (VNS), and 6) deep brain stimulation (DBS). Most of the neurostimulation treatments have been investigated in patients with varying degrees of treatment resistance. CONCLUSIONS There is increasing evidence for efficacy, tolerability, and safety of neurostimulation treatments. rTMS is now a first-line recommendation for patients with MDD who have failed at least 1 antidepressant. ECT remains a second-line treatment for patients with treatment-resistant depression, although in some situations, it may be considered first line. Third-line recommendations include tDCS and VNS. MST and DBS are still considered investigational treatments.
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Affiliation(s)
- Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | | | - Jonathan Downar
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Simon Patry
- Department of Psychiatry, L'Université Laval, Québec City, Québec
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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