Skip to main content Accessibility help
×
Home
Hostname: page-component-55b6f6c457-s8qdg Total loading time: 0.21 Render date: 2021-09-25T03:20:16.641Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

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
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:urini@clalit.org.il (U. Nitzan).
Get access

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.

Type
Original article
Copyright
Copyright © European Psychiatric Association 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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): 3138.10.1097/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): 188200.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): 283290.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): 6673.CrossRefGoogle ScholarPubMed
Levkovitz, Y, et al.A randomized-controlled feasibility and safety study of deep transcranial magnetic stimulation. Clin Neurophysiol 2007; 118(12): 27302744.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): 298306.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): 6473.10.1002/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: 7383.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): 971974.10.1016/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: 107115.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): 177184.CrossRefGoogle ScholarPubMed
Rutherford, BRRoose, SPA model of placebo response in antidepressant clinical trials. Am J Psychiatry 2013; 170(7): 723733.10.1176/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): 2840.CrossRefGoogle ScholarPubMed
Paykel, ESFreeling, PHollyman, JAAre tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry 1988; 21(1): 1518.CrossRefGoogle ScholarPubMed
Fournier, JC, et al.Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA 2010; 303(1): 4753.10.1001/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): 12271237.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): 501507.10.1192/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): 176185.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): 124138.10.1176/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): 126135.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: 224232.CrossRefGoogle ScholarPubMed
Fava, GAOffidani, EThe mechanisms of tolerance in antidepressant action. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35(7): 15931602.10.1016/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): 567573.10.4088/JCP.11m07413CrossRefGoogle ScholarPubMed
Supplementary material: File

Feffer et al. supplementary material

Supplementary material 1

Download Feffer et al. supplementary material(File)
File 25 KB
Supplementary material: File

Feffer et al. supplementary material

Supplementary material 2

Download Feffer et al. supplementary material(File)
File 34 KB
Supplementary material: File

Feffer et al. supplementary material

Supplementary material 3

Download Feffer et al. supplementary material(File)
File 24 KB
Submit a response

Comments

No Comments have been published for this article.
6
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

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
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *