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Academic Journal
DEPRESSION
| Title: |
Safety, Tolerability, and Effectiveness of High Doses of Adjunctive Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression in a Clinical Setting
| | Date: | 2010 | | Author(s): |
Hadley D, Anderson BS, Borckardt JJ, Arana A, Li X, Nahas Z, George MS
| | Source: | Journal of ECT | | Abstract: |
Objective: Daily left prefrontal repetitive transcranial magnetic stimulation (rTMS) recently received Food and Drug Administration (FDA) approval for the treatment of depression and offers an alternative to traditional approaches. This approval was based on a study using 3000 stimuli per day (15,000 stimuli per week) in adults with unipolar depression not taking antidepressant medications. Several meta-analyses suggest a dose-response relationship with TMS. This study was carried out before US FDA approval to test the safety, tolerability, and effectiveness of adjunctive high-dose left prefrontal rTMS in a clinical setting with particular attention to safety of higher doses and potential interactions with antidepressant medications, speed of response, and effects on suicidality.
Method: We enrolled 19 patients who were in a current major depressive episode with treatment-resistant unipolar or bipolar depression and treated them in their acute episode and in a maintenance fashion for18 months. The patients received daily left prefrontal rTMS at 120%resting motor threshold, 10 Hz, 5 seconds on, and 10 seconds off and for a mean of 6800 stimuli per session (34,000 stimuli per week), more than twice the dose delivered in the pivotal FDA trial. All patients continued antidepressant medication throughout the rTMS treatment; thus rTMS was an adjunctive treatment. We measured adverse effects, depression, quality of life, suicidal ideation, and social and physical functioning.
Results: These higher rTMS doses were well tolerated without significant adverse effects or adverse events. All measured dimensions showed improvement, with many showing improvement in 1 to 2 weeks. Of perhaps most importance, suicidal ideation diminished in 67% of the patients after just 1 week.
Conclusions: These uncontrolled data suggest that higher doses of daily left prefrontal rTMS may safely be used in outpatients with major depressive episode even as an adjunctive treatment.
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| | Title: |
HF-rTMS treatment decreases psychomotor retardation in medication-resistant melancholic depression
| | Date: | 2010 | | Author(s): |
Baeken C, De Raedt R, Santermans L, Zeeuws D, Vanderhasselt MA, Meers M, Vanderbruggen N.
| | Source: | Progress in Neuro-Psychopharmacology and Biological Psychiatry | | Abstract: |
Repetitive Transcranial Magnetic Stimulation (rTMS) applied to the left dorsolateral prefrontal cortex (DLPFC) 21 might be a promising treatment strategy for depression. As one of the key features of melancholic depression is 22 disturbances in psychomotor activity, we wanted to evaluate whether HF-rTMS treatment could influence 23 psychomotor symptoms. Twenty antidepressant-free unipolar melancholic depressed patients, all at least 24 stage III medication-resistant, were studied. All were treated with 10 sessions of High-Frequency (HF)-rTMS 25 applied to the left dorsolateral prefrontal cortex (DLPFC) under MRI guidance. Forty percent of the patients 26 showed a reduction of at least 50% on their initial 17-item Hamilton Depression Rating Score (HDRS) scale and 27 were defined as clinical responders. Regardless of clinical outcome HF-rTMS treatment resulted in significant 28 decreases on the Depressive Retardation Rating Scale (DRRS) scores. Although this was an open study in a 29 relatively small sample, our results suggest that HF-rTMS might act on the ‘psychomotor’ level and these 30 findings could add some further information as to why this kind of treatment can be beneficial for severely depressed patients of the melancholic subtype.
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| | Title: |
Acute effects of repetitive transcranial magnetic stimulation on attentional control are related to antidepressant outcomes
| | Date: | 2010 | | Author(s): |
Vanderhasselt MA, De Raedt R, Leyman L, Baeken C
| | Source: | Journal of Psychiatry Neuroscience | | Abstract: |
Background: Repetitive transcranial magnetic stimulation (rTMS) applied over the dorsolateral prefrontal cortex (DLPFC) is a new treatment procedure that holds promise of more insight into the pathophysiology of depression because the DLPFC may play an important role in the interplay between emotional and attentional information processing. We sought to investigate whether acute neurocognitive effects of rTMS are related to antidepressant outcomes. Methods: Between January 2005 and May 2007, we examined the effects of a single session compared with 2 weeks of rTMS over the left DLPFC on cognition and mood in therapy-resistant patients with depression.We used a crossover placebo-controlled double-blind design and differentiated rTMS treatment responders and nonresponders. We used a task-switching paradigm to measure cognitive function. Results: After 2 weeks of high-frequency rTMS over the left DLPFC, depressive symptoms improved in more than half (53%) of our therapy-resistant population. After a single session, mood did not improve but attentional control was increased solely within our group of treatment responders. Limitations: Our results should be interpreted as preliminary because our sample was small and because the cognitive task we used has not been tested for validity and reliability. In addition, despite minimal stimulation of the DLPFC during sham stimulation, it is possible that the stiumlation was partially active. Finally, benzodiazepines may have had impairing effects on the attentional task. Conclusion: Cognitive reactivity after a single session of rTMS may hold promise as a predictor of beneficial treatment outcomes. Moreover, within the group of responders, attentional control appears to play an important role in the progress of mood disorders.
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