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A randomized trial of unilateral and bilateral prefrontal cortex transcranial magnetic stimulation in treatment-resistant major depression

Published online by Cambridge University Press:  07 October 2010

P. B. Fitzgerald ,
K. Hoy ,
R. Gunewardene ,
C. Slack ,
S. Ibrahim ,
M. Bailey  and
Z. J. Daskalakis
P. B. Fitzgerald*
Affiliation:
Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia The Victoria Clinic, Prahran, Victoria, Australia
K. Hoy
Affiliation:
Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia
R. Gunewardene
Affiliation:
Mosman Private Hospital, Mosman, New South Wales, Australia
C. Slack
Affiliation:
Pine Rivers Private Hospital, Strathpine, Queensland, Australia
S. Ibrahim
Affiliation:
Northpark Private Hospital, Bundoora, Victoria, Australia
M. Bailey
Affiliation:
Monash University Department of Epidemiology and Preventive Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Z. J. Daskalakis
Affiliation:
Centre for Addiction and Mental Health, Clarke Division, Toronto, Ontario, Canada
*
*Address for correspondence: Professor P. B. Fitzgerald, M.B.B.S., M.P.M., Ph.D., F.R.A.N.Z.C.P., Monash Alfred Psychiatry Research Centre, First Floor, Old Baker Building, The Alfred, Commercial Rd, Melbourne, Victoria 3004, Australia. (Email: [email protected])
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Abstract

Background

Although several studies have reported that repetitive transcranial magnetic stimulation (rTMS) treatment has demonstrable efficacy in patients with depression, the parameters needed to optimize therapeutic efficacy remain unclear. To this end we determined the efficacy of low-frequency right rTMS to the dorsolateral prefrontal cortex (DLPFC) compared to two forms of bilateral rTMS to the DLPFC: (1) sequential low-frequency right-sided followed by high-frequency left-sided rTMS and (2) sequential low-frequency rTMS to both hemispheres.

Method

A total of 219 patients with treatment-resistant depression (TRD) were randomized to a 4-week course of rTMS applied with one of the three treatment conditions. Outcomes were assessed with standard rating scales.

Results

Overall, slightly more than 50% of the patients achieved clinical response criteria. There was no substantial difference in response between the unilateral and bilateral treatment groups. Successful response to rTMS was predicted by a greater degree of baseline depression severity.

Conclusions

There is no substantial difference in efficacy between unilateral right-sided rTMS and the two forms of bilateral rTMS assessed in the study. Furthermore, our results call into question the specificity between frequency and laterality and rTMS response.

Keywords

Antidepressantdepressionprefrontal cortexremissionrepetitive transcranial magnetic stimulationresponse
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 6 , June 2011 , pp. 1187 - 1196
Copyright
Copyright © Cambridge University Press 2010

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References

Bech, P, Kastrup, M, Rafaelsen, OJ (1986). Mini-compendium of rating scales for states of anxiety, depression, mania and schizophrenia with corresponding DSM-III syndromes. Acta Psychiatrica Scandinavica (Suppl.) 326, 1–37.Google ScholarPubMed
Beck, AT, Epstein, N, Brown, G, Steer, RA (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893–897.CrossRefGoogle ScholarPubMed
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Berman, RM, Narasimhan, M, Sanacora, G, Miano, AP, Hoffman, RE, Hu, XS, Charney, DS, Boutros, NN (2000). A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression. Biological Psychiatry 47, 332–337.CrossRefGoogle ScholarPubMed
Burt, T, Lisanby, SH, Sackeim, HA (2002). Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis. International Journal of Neuropsychopharmacology 5, 73–103.CrossRefGoogle ScholarPubMed
Conca, A, Di Pauli, J, Beraus, W, Hausmann, A, Peschina, W, Schneider, H, Konig, P, Hinterhuber, H (2002). Combining high and low frequencies in rTMS antidepressive treatment: preliminary results. Human Psychopharmacology 17, 353–356.CrossRefGoogle ScholarPubMed
Daskalakis, ZJ, Levinson, AJ, Fitzgerald, PB (2008). Repetitive transcranial magnetic stimulation for major depressive disorder: a review. Canadian Journal of Psychiatry 53, 555–566.CrossRefGoogle ScholarPubMed
Dragasevic, N, Potrebic, A, Damjanovic, A, Stefanova, E, Kostic, VS (2002). Therapeutic efficacy of bilateral prefrontal slow repetitive transcranial magnetic stimulation in depressed patients with Parkinson's disease: an open study. Movement Disorders 17, 528–532.CrossRefGoogle ScholarPubMed
Fava, M (2003). Diagnosis and definition of treatment-resistant depression. Biological Psychiatry 53, 649–659.CrossRefGoogle ScholarPubMed
Feinsod, M, Kreinin, B, Chistyakov, A, Klein, E (1998). Preliminary evidence for a beneficial effect of low-frequency, repetitive transcranial magnetic stimulation in patients with major depression and schizophrenia. Depression and Anxiety 7, 65–68.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Fitzgerald, PB, Benitez, J, de Castella, A, Daskalakis, ZJ, Brown, TL, Kulkarni, J (2006 a). A randomized, controlled trial of sequential bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression. American Journal of Psychiatry 163, 88–94.CrossRefGoogle ScholarPubMed
Fitzgerald, PB, Brown, TL, Marston, NAU, Daskalakis, ZJ, de Castella, A, Kulkarni, J (2003). Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Archives of General Psychiatry 60, 1002–1008.CrossRefGoogle ScholarPubMed
Fitzgerald, PB, Fountain, S, Daskalakis, ZJ (2006 b). A comprehensive review of the effects of rTMS on motor cortical excitability and inhibition. Clinical Neurophysiology 117, 2584–2596.CrossRefGoogle ScholarPubMed
Fitzgerald, PB, Hoy, K, Daskalakis, ZJ, Kulkarni, J (2009). A randomized trial of the anti-depressant effects of low- and high-frequency transcranial magnetic stimulation in treatment-resistant depression. Depression and Anxiety 26, 229–234.CrossRefGoogle ScholarPubMed
Fitzgerald, PB, Huntsman, S, Gunewardene, R, Kulkarni, J, Daskalakis, ZJ (2006 c). A randomized trial of low-frequency right-prefrontal-cortex transcranial magnetic stimulation as augmentation in treatment-resistant major depression. International Journal of Neuropsychopharmacology 9, 655–666.CrossRefGoogle ScholarPubMed
Fitzgerald, PB, Sritharan, A, Daskalakis, ZJ, de Castella, AR, Kulkarni, J, Egan, G (2007). A functional magnetic resonance imaging study of the effects of low frequency right prefrontal transcranial magnetic stimulation in depression. Journal of Clinical Psychopharmacology 27, 488–492.CrossRefGoogle ScholarPubMed
Fregni, F, Marcolin, MA, Myczkowski, M, Amiaz, R, Hasey, G, Rumi, DO, Rosa, M, Rigonatti, SP, Camprodon, J, Walpoth, M, Heaslip, J, Grunhaus, L, Hausmann, A, Pascual-Leone, A (2006). Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation. International Journal of Neuropsychopharmacology 9, 641–654.CrossRefGoogle ScholarPubMed
George, MS, Nahas, Z, Molloy, M, Speer, AM, Oliver, NC, Li, XB, Arana, GW, Risch, SC, Ballenger, JC (2000). A controlled trial of daily left prefrontal cortex TMS for treating depression. Biological Psychiatry 48, 962–970.CrossRefGoogle ScholarPubMed
George, MS, Wassermann, EM, Williams, WA, Callahan, A, Ketter, TA, Basser, P, Hallett, M, Post, RM (1995). Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. NeuroReport 6, 1853–1856.CrossRefGoogle ScholarPubMed
Grunhaus, L, Schreiber, S, Dolberg, OT, Polak, D, Dannon, PN (2003). A randomized controlled comparison of electroconvulsive therapy and repetitive transcranial magnetic stimulation in severe and resistant nonpsychotic major depression. Biological Psychiatry 53, 324–331.CrossRefGoogle ScholarPubMed
Hamilton, M (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.CrossRefGoogle ScholarPubMed
Hausmann, A, Kemmler, G, Walpoth, M, Mechtcheriakov, S, Kramer-Reinstadler, K, Lechner, T, Walch, T, Deisenhammer, EA, Kofler, M, Rupp, CI, Hinterhuber, H, Conca, A (2004). No benefit derived from repetitive transcranial magnetic stimulation in depression: a prospective, single centre, randomised, double blind, sham controlled ‘add on’ trial. Journal of Neurology, Neurosurgery and Psychiatry 75, 320–322.Google ScholarPubMed
Isenberg, K, Downs, D, Pierce, K, Svarakic, D, Garcia, K, Jarvis, M, North, C, Kormos, TC (2005). Low frequency rTMS stimulation of the right frontal cortex is as effective as high frequency rTMS stimulation of the left frontal cortex for antidepressant-free, treatment-resistant depressed patients. Annals of Clinical Psychiatry 17, 153–159.CrossRefGoogle ScholarPubMed
Jorge, RE, Moser, DJ, Acion, L, Robinson, RG (2008). Treatment of vascular depression using repetitive transcranial magnetic stimulation. Archives of General Psychiatry 65, 268–276.CrossRefGoogle ScholarPubMed
Kauffmann, CD, Cheema, MA, Miller, BE (2004). Slow right prefrontal transcranial magnetic stimulation as a treatment for medication-resistant depression: a double-blind, placebo-controlled study. Depression and Anxiety 19, 59–62.CrossRefGoogle ScholarPubMed
Klein, E, Kreinin, I, Chistyakov, A, Koren, D, Mecz, L, Marmur, S, Ben-Shachar, D, Feinsod, M (1999). Therapeutic efficacy of right prefrontal slow repetitive transcranial magnetic stimulation in major depression: a double-blind controlled trial. Archives of General Psychiatry 56, 315–320.CrossRefGoogle Scholar
Lam, RW, Chan, P, Wilkins-Ho, M, Yatham, LN (2008). Repetitive transcranial magnetic stimulation for treatment-resistant depression: a systematic review and metaanalysis. Canadian Journal of Psychiatry 53, 621–631.CrossRefGoogle ScholarPubMed
Lisanby, SH, Gutman, D, Luber, B, Schroeder, C, Sackeim, HA (2001). Sham TMS: intracerebral measurement of the induced electrical field and the induction of motor-evoked potentials. Biological Psychiatry 49, 460–463.CrossRefGoogle ScholarPubMed
Mallinckrodt, C, Clark, W, David, S (2001 a). Accounting for dropout bias using mixed-effects models. Journal of Biopharmaceutical Statistics 11, 9–21.CrossRefGoogle ScholarPubMed
Mallinckrodt, C, Clark, W, David, S (2001 b). Type I error rates from mixed effects model repeated measures compared with fixed effects ANOVA with missing values imputed via LOCF. Drug Information Journal 35, 1215–1225.CrossRefGoogle Scholar
Manes, F, Jorge, R, Morcuende, M, Yamada, T, Paradiso, S, Robinson, RG (2001). A controlled study of repetitive transcranial magnetic stimulation as a treatment of depression in the elderly. International Psychogeriatrics 13, 225–231.CrossRefGoogle ScholarPubMed
McNamara, B, Ray, JL, Arthurs, OJ, Boniface, S (2001). Transcranial magnetic stimulation for depression and other psychiatric disorders. Psychological Medicine 31, 1141–1146.CrossRefGoogle ScholarPubMed
Mosimann, UP, Schmitt, W, Greenberg, BD, Kosel, M, Muri, RM, Berkhoff, M, Hess, CW, Fisch, HU, Schlaepfer, TE (2004). Repetitive transcranial magnetic stimulation: a putative add-on treatment for major depression in elderly patients. Psychiatry Research 126, 123–133.CrossRefGoogle ScholarPubMed
O'Reardon, JP, Solvason, HB, Janicak, PG, Sampson, S, Isenberg, KE, Nahas, Z, McDonald, WM, Avery, D, Fitzgerald, PB, Loo, C, Demitrack, MA, George, MS, Sackeim, HA (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biological Psychiatry 62, 1208–1216.CrossRefGoogle ScholarPubMed
Padberg, F, Zwanzger, P, Thoma, H, Kathmann, N, Haag, C, Greenberg, BD, Hampel, H, Moller, HJ (1999). Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and sham rTMS. Psychiatry Research 88, 163–171.CrossRefGoogle ScholarPubMed
Pridmore, S, Fernandes Filho, JA, Nahas, Z, Liberatos, C, George, MS (1998). Motor threshold in transcranial magnetic stimulation: a comparison of a neurophysiological method and a visualization of movement method. Journal of ECT 14, 25–27.CrossRefGoogle Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 22–33.Google ScholarPubMed
Speer, AM, Benson, BE, Kimbrell, TK, Wassermann, EM, Willis, MW, Herscovitch, P, Post, RM (2009). Opposite effects of high and low frequency rTMS on mood in depressed patients: relationship to baseline cerebral activity on PET. Journal of Affective Disorders 115, 386–394.CrossRefGoogle ScholarPubMed
Thase, ME, Rush, AJ (1997). When at first you don't succeed: sequential strategies for antidepressant nonresponders. Journal of Clinical Psychiatry 58 (Suppl. 13), 23–29.Google ScholarPubMed