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Wilke SA, Johnson CL, Corlier J, Marder KG, Wilson AC, Pleman CM, Leuchter AF. Psychostimulant use and clinical outcome of repetitive transcranial magnetic stimulation treatment of major depressive disorder. Depress Anxiety 2022; 39:397-406. [PMID: 35389536 DOI: 10.1002/da.23255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/24/2022] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD). Psychostimulant medication use may be associated with improved rTMS outcomes, but a detailed understanding of these relationships is lacking. METHODS We compared MDD subjects taking psychostimulants (n = 37) with those not taking one of these medications (n = 53) during a course of 30 rTMS treatments. Changes in the 30-item Inventory of Depressive Symptomatology Self Report (IDS-SR30) subscale scores were examined at treatment 30. We also subdivided subjects into three categories based on drug mechanism and looked at IDS-SR30 total score after treatments 10, 20, and 30. RESULTS Subjects taking psychostimulants had a significantly greater overall clinical improvement than those not taking these medications at treatment 30. The psychostimulant group also improved significantly more than the control group in "sleep" and "mood/cognition," but not "anxiety/arousal" IDS-SR30 subscales. No differences were detected among individual drug categories, which may reflect the limited sample size for individual medications. There was a negative dose-response relationship for the lisdexamfetamine/dextroamphetamine group, in which lower doses were associated with better clinical outcome. CONCLUSIONS Psychostimulant medications may enhance clinical efficacy of rTMS for MDD by preferentially impacting specific symptom domains. For some psychostimulants, these effects may be dose-dependent. Prospective clinical trials are needed to guide psychostimulant augmentation of brain stimulation therapies.
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Affiliation(s)
- Scott A Wilke
- Neuromodulation Division, TMS Clinical and Research Service, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Crystal L Johnson
- Neuromodulation Division, TMS Clinical and Research Service, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Juliana Corlier
- Neuromodulation Division, TMS Clinical and Research Service, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Katharine G Marder
- Neuromodulation Division, TMS Clinical and Research Service, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Andrew C Wilson
- Neuromodulation Division, TMS Clinical and Research Service, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Christopher M Pleman
- Neuromodulation Division, TMS Clinical and Research Service, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Andrew F Leuchter
- Neuromodulation Division, TMS Clinical and Research Service, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
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Mirman AM, Corlier J, Wilson AC, Tadayonnejad R, Marder KG, Pleman CM, Krantz DE, Wilke SA, Levitt JG, Ginder ND, Ojha R, Daskalakis ZJ, Leuchter AF, Lee JC. Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder. Depress Anxiety 2022; 39:123-133. [PMID: 34990046 DOI: 10.1002/da.23237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/06/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms of major depressive disorder (MDD) are reported to change early in treatment with repetitive transcranial magnetic stimulation (rTMS). We evaluated early changes in sleep, anxiety, and mood as predictors of nonresponse to rTMS treatment. METHODS Three hundred twenty-nine subjects with nonpsychotic MDD completed a 6-week course of rTMS treatment. Subjects were stratified by the severity of their baseline depression, and had their overall depressive symptoms recorded every week of treatment. We evaluated lack of improvement in sleep, anxiety, and mood symptoms after 1 and 2 weeks as potential predictors of eventual nonresponse, defined as <50% improvement in compositive depressive symptoms after 6 weeks. This was measured as negative predictive value (NPV; the likelihood that lack of early symptom improvement accurately predicted eventual treatment nonresponse). RESULTS Subjects with severe or very severe baseline depression achieving <20% improvement in mood at 1 week were correctly predicted as nonresponders with NPVs largely >90%. At 2 weeks, subjects with very severe baseline depression who failed to demonstrate any improvement in mood were all nonresponders. Lack of improvement in sleep at 2 weeks was also a significant predictor. CONCLUSIONS Identifying a lack of early mood improvement is a practical and robust method to predict rTMS nonresponse. This suggests a treatment protocol change may be indicated in patients with more severe baseline depression showing minimal early mood improvement.
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Affiliation(s)
- Alex M Mirman
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Juliana Corlier
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Andrew C Wilson
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Reza Tadayonnejad
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
| | - Katharine G Marder
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Christopher M Pleman
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David E Krantz
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Scott A Wilke
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer G Levitt
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nathaniel D Ginder
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Rashi Ojha
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Andrew F Leuchter
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jonathan C Lee
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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