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Factors associated with response after deep transcranial magnetic stimulation in a real-world clinical setting: Results from the first 40 cases of treatment-resistant depression

Published online by Cambridge University Press:  23 March 2020

K. Feffer ,
K.A.B. Lapidus ,
Y. Braw ,
Y. Bloch ,
S. Kron ,
R. Netzer  and
U. Nitzan
K. Feffer
Affiliation:
Shalvata Mental Health Center, Hod-Hasharon, Sackler School of Medicine, Tel-Aviv University, P.O.B 94, Tel-Aviv, Israel
K.A.B. Lapidus
Affiliation:
Northwell Health Department of Psychiatry, Lenox Hill Hospital, New York, NY, USA
Y. Braw
Affiliation:
Department of Behavioral Sciences, Ariel University, Ariel, Israel
Y. Bloch
Affiliation:
Shalvata Mental Health Center, Hod-Hasharon, Sackler School of Medicine, Tel-Aviv University, P.O.B 94, Tel-Aviv, Israel
S. Kron
Affiliation:
Shalvata Mental Health Center, Hod-Hasharon, Sackler School of Medicine, Tel-Aviv University, P.O.B 94, Tel-Aviv, Israel
R. Netzer
Affiliation:
Shalvata Mental Health Center, Hod-Hasharon, Tel-Aviv, Israel
U. Nitzan*
Affiliation:
Shalvata Mental Health Center, Hod-Hasharon, Sackler School of Medicine, Tel-Aviv University, P.O.B 94, Tel-Aviv, Israel
*
* Corresponding author. Fax: +972 3 5496872. E-mail address:[email protected] (U. Nitzan).
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Abstract

Background:

Deep transcranial magnetic stimulation (dTMS) has been sanctioned by the United States Food and Drug Administration for treatment-resistant depression. In a retrospective cohort study, we evaluated response and effectiveness of dTMS in real-world practice, as an add-on treatment for resistant depression.

Methods:

Forty adult outpatients suffering from depression, all taking psychiatric medications, underwent 20 dTMS treatments over a 4–6 week period. At baseline (T0), visit 10 (T1), and visit 20 (T2), the Clinical Global Impression-Severity (CGI-S) scale was administered, and the Clinical Global Impression Improvement (CGI-I) scale was completed at T1 and T2; the Hamilton Depression Rating Scale (HDRS-21) was administrated at T0 and T2 only. The patients also completed the Quick Inventory of Depressive Symptoms–Self-Report (QIDS-SR) at T0, T1, and T2.

Results:

Depressive symptoms (HDRS-21 total score) decreased significantly following treatment. The HDRS total score decreased from an average of 21.22 (± 6.09) at T0, to 13.95 (± 7.24) at T2. Correspondingly, at T2, 32.5% were responders to the treatment and 20% were in remission, based on the HDRS-21. Treatment was well tolerated, with a discontinuation rate of 7.5%. While depressive symptoms at baseline did not predict remission/response at T2, higher HDRS scores at T0 were associated with a larger decrease in depressive symptoms during the study.

Conclusions:

Significant antidepressant effects were seen following 20 dTMS treatments, given as augmentation to ongoing medications in treatment-resistant depression. The findings suggest that among patients with TRD, the severity of the depressive episode (and not necessarily the number of failed antidepressant medication trials) is associated with a positive therapeutic effect of dTMS. Hence, the initial severity of the depressive episode may guide clinicians in referring patients for dTMS.

Keywords

Deep transcranial magnetic stimulationTreatment-resistant depressionBipolar disorderAugmentation
Type
Original article
Information
European Psychiatry , Volume 44 , July 2017 , pp. 61 - 67
Copyright
Copyright © European Psychiatric Association 2017

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References

Roth, Y, et al.Three-dimensional distribution of the electric field induced in the brain by transcranial magnetic stimulation using figure-8 and deep H-coils. J Clin Neurophysiol 2007; 24(1): 31–38.10.1097/WNP.0b013e31802fa393CrossRefGoogle ScholarPubMed
Levkovitz, Y, et al.Deep transcranial magnetic stimulation over the prefrontal cortex: evaluation of antidepressant and cognitive effects in depressive patients. Brain Stimul 2009; 2(4): 188–200.CrossRefGoogle ScholarPubMed
Ceccanti, M, et al.Deep TMS on alcoholics: effects on cortisolemia and dopamine pathway modulation. A pilot study. Can J Physiol Pharmacol 2015; 93(4): 283–290.CrossRefGoogle ScholarPubMed
Girardi, P, et al.Add-on deep transcranial magnetic stimulation (dTMS) in patients with dysthymic disorder comorbid with alcohol use disorder: a comparison with standard treatment. World J Biol Psychiatry 2015; 16(1): 66–73.CrossRefGoogle ScholarPubMed
Levkovitz, Y, et al.A randomized-controlled feasibility and safety study of deep transcranial magnetic stimulation. Clin Neurophysiol 2007; 118(12): 2730–2744.CrossRefGoogle ScholarPubMed
Harel, EV, et al.H-coil repetitive transcranial magnetic stimulation for treatment-resistant major depressive disorder: an 18-week continuation safety and feasibility study. World J Biol Psychiatry 2014; 15(4): 298–306.CrossRefGoogle ScholarPubMed
Levkovitz, Y, et al.Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized-controlled trial. World Psychiatry 2015; 14(1): 64–73.10.1002/wps.20199CrossRefGoogle ScholarPubMed
Kedzior, KK, et al.Deep transcranial magnetic stimulation (DTMS) in the treatment of major depression: An exploratory systematic review and meta-analysis. J Affect Disord 2015; 187: 73–83.CrossRefGoogle ScholarPubMed
Kedzior, KK, et al.Acute reduction in anxiety after deep transcranial magnetic stimulation (DTMS) in unipolar major depression – a systematic review and meta-analysis. Psychiatry Res 2015; 230(3): 971–974.10.1016/j.psychres.2015.11.032CrossRefGoogle ScholarPubMed
Kedzior, KK, et al.Cognitive functioning and deep transcranial magnetic stimulation (DTMS) in major psychiatric disorders: a systematic review. J Psychiatr Res 2016; 75: 107–115.CrossRefGoogle ScholarPubMed
American Psychiatric Association Diagnostic criteria from DSM-IV-TR Washington, DC: American Psychiatric Association; 2000 [xii, 370 p.].Google Scholar
Fekadu, A, et al.A multidimensional tool to quantify treatment resistance in depression: the Maudsley staging method. J Clin Psychiatry 2009; 70(2): 177–184.CrossRefGoogle ScholarPubMed
Rutherford, BRRoose, SPA model of placebo response in antidepressant clinical trials. Am J Psychiatry 2013; 170(7): 723–733.10.1176/appi.ajp.2012.12040474CrossRefGoogle Scholar
Trivedi, MH, et al.Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006; 163(1): 28–40.CrossRefGoogle ScholarPubMed
Paykel, ESFreeling, PHollyman, JAAre tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry 1988; 21(1): 15–18.CrossRefGoogle ScholarPubMed
Fournier, JC, et al.Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA 2010; 303(1): 47–53.10.1001/jama.2009.1943CrossRefGoogle ScholarPubMed
Gueorguieva, RMallinckrodt, CKrystal, JHTrajectories of depression severity in clinical trials of duloxetine: insights into antidepressant and placebo responses. Arch Gen Psychiatry 2011; 68(12): 1227–1237.CrossRefGoogle ScholarPubMed
Thase, MELarsen, KGKennedy, SHAssessing the ‘true’ effect of active antidepressant therapy v. placebo in major depressive disorder: use of a mixture model. Br J Psychiatry 2011; 199(6): 501–507.10.1192/bjp.bp.111.093336CrossRefGoogle ScholarPubMed
Downar, J, et al.Anhedonia and reward-circuit connectivity distinguish non-responders from responders to dorsomedial prefrontal repetitive transcranial magnetic stimulation in major depression. Biol Psychiatry 2014; 76(3): 176–185.CrossRefGoogle Scholar
Phillips, ML, et al.Identifying predictors, moderators, and mediators of antidepressant response in major depressive disorder: neuroimaging approaches. Am J Psychiatry 2015; 172(2): 124–138.10.1176/appi.ajp.2014.14010076CrossRefGoogle ScholarPubMed
Sinyor, MSchaffer, ALevitt, AThe sequenced treatment alternatives to relieve depression (STAR*D) trial: a review. Can J Psychiatry 2010; 55(3): 126–135.CrossRefGoogle ScholarPubMed
Balestri, M, et al.Socio-demographic and clinical predictors of treatment-resistant depression: a prospective European multicenter study. J Affect Disord 2016; 189: 224–232.CrossRefGoogle ScholarPubMed
Fava, GAOffidani, EThe mechanisms of tolerance in antidepressant action. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35(7): 1593–1602.10.1016/j.pnpbp.2010.07.026CrossRefGoogle ScholarPubMed
Connolly, KRHelmer, ACristancho, MACristancho, PO’Reardon, JPeffectiveness of transcranial magnetic stimulation in clinical practice post-FDA approval in the United States: results observed with the first 100 consecutive cases of depression at an academic medical center. J Clin Psychiatry 2012; 73(4): 567–573.10.4088/JCP.11m07413CrossRefGoogle ScholarPubMed
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