5‐Hz Transcranial Magnetic Stimulation for Comorbid Posttraumatic Stress Disorder and Major Depression

Philip, Noah S.; Ridout, Samuel J.; Albright, Sarah E.; Sánchez, George I.; Carpenter, Linda L.

doi:10.1002/jts.22065

Cited by 54 publications

(60 citation statements)

References 26 publications

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“…During the active and continuation phase, we observed increased antidepressant resistance predicted poorer response, which is consistent with prior observations (Lisanby et al., ). Furthermore, anxiety symptoms emerged as a predictor of positive response in this study, a finding that is broadly supportive of prospectively testing sTMS in other disorders where anxiety is prominent or comorbid (Carpenter et al., ; Diefenbach et al., ; Philip et al., ).…”

Section: Discussionsupporting

confidence: 79%

Predictors of response to synchronized transcranial magnetic stimulation for major depressive disorder

Philip

Leuchter²,

Cook

et al. 2018

Depress Anxiety

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Background Synchronized transcranial magnetic stimulation (sTMS) is a new modality to reduce symptoms of major depressive disorder (MDD). sTMS uses rotating neodymium magnets to deliver low‐field stimulation matched to the individual alpha frequency (IAF). A previous multisite study showed that sTMS significantly reduced MDD symptoms in the per‐protocol sample. To this end, we evaluated clinical features associated with optimal sTMS outcomes. Methods Using the per‐protocol sample (n = 120) from the parent sham‐controlled trial, we performed univariate and stepwise linear regression to identify predictors of response after 6 weeks of sTMS. A subsample (n = 83) that entered a 4‐week open/active continuation phase also was examined. Candidate variables included age, sex, comorbid anxiety, number of failed antidepressants in the current depressive episode, MDD severity (17‐item Hamilton Depression Rating Scale; HAMD17), anxiety symptom severity (HAMD17 anxiety/somatization factor), and IAF. Results We found that greater baseline depressive (p < 0.001) and anxiety (p < 0.001) symptom severity were associated with better response to active sTMS, whereas fewer failed antidepressant trials predicted superior response to sham (p < 0.001). MDD severity and antidepressant resistance predicted outcomes in open/active phase sTMS; lower IAF predicted poorer response in participants who received 10 weeks of active sTMS (p = 0.001). Conclusions Participants with greater severity of depression and higher anxiety had superior responses to active sTMS, whereas treatment naïve individuals exhibited a greater response to sham. These results lend support to the primary efficacy findings, and support further investigation of sTMS as a therapeutic noninvasive brain stimulation modality.

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Section: Discussionsupporting

confidence: 79%

Predictors of response to synchronized transcranial magnetic stimulation for major depressive disorder

Philip

Leuchter²,

Cook

et al. 2018

Depress Anxiety

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“…The treatment of PTSD with TMS is the most studied among the conditions of interest. Nine studies were included in this meta-analysis (Boggio et al, 2010;Cohen et al, 2004;Isserles et al, 2013;Nam, Pae, & Chae, 2013;Osuch et al, 2009;Oznur et al, 2014;Philip, Ridout, Albright, Sanchez, & Carpenter, 2016;Rosenberg et al, 2002;Watts et al, 2012). The funnel plot is symmetric (p = 0.992, Egger's test), suggesting that publication bias is unlikely.…”

Section: Tms and Posttraumatic Stress Disordermentioning

confidence: 99%

“…All studies applied 1-20 Hz rTMS with traditional figure-ofeight coils to either the right or left DLPFC or both, with the exception of one study that evaluated the effect of dTMS to the medial PFC (mPFC) (Isserles et al, 2013). Six studies administered 10-15 sessions (Boggio et al, 2010;Cohen et al, 2004;Isserles et al, 2013;Nam et al, 2013;Rosenberg et al, 2002;Watts et al, 2012), two administered 20 sessions (Osuch et al, 2009;Oznur et al, 2014), and one 36 sessions (Philip et al, 2016). Concerning the sample characteristics, two studies assessed combat-related PTSD, and in one of these studies, all patients had a history of substance abuse (Oznur et al, 2014;Rosenberg et al, 2002).…”

Section: Tms and Posttraumatic Stress Disordermentioning

confidence: 99%

“…Concerning the sample characteristics, two studies assessed combat-related PTSD, and in one of these studies, all patients had a history of substance abuse (Oznur et al, 2014;Rosenberg et al, 2002). Also, four studies evaluated comorbid PTSD and MDD (Isserles et al, 2013;Osuch et al, 2009;Philip et al, 2016;Rosenberg et al, 2002). Three of the RCT consisted of three treatment groups (Boggio et al, 2010;Cohen et al, 2004;Isserles et al, 2013).…”

Section: Tms and Posttraumatic Stress Disordermentioning

confidence: 99%

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Transcranial magnetic stimulation in anxiety and trauma‐related disorders: A systematic review and meta‐analysis

et al. 2019

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Background Transcranial magnetic stimulation (TMS) has been evaluated as an effective treatment option for patients with major depressive disorder. However, there are limited studies that have evaluated the efficacy of TMS for other neuropsychiatric disorders such as anxiety and trauma‐related disorders. We reviewed the literature that has evaluated TMS as a treatment for anxiety and trauma‐related disorders. Methods We searched for articles published up to December 2017 in Embase, Medline, and ISI Web of Science databases, following the Preferred Items for Reporting of Systematic Reviews and Meta‐Analyses (PRISMA) statement. Articles ( n = 520) evaluating TMS in anxiety and trauma‐related disorders were screened and a small subset of these that met the eligibility criteria ( n = 17) were included in the systematic review, of which nine evaluated TMS in posttraumatic stress disorder (PTSD), four in generalized anxiety disorder (GAD), two in specific phobia (SP), and two in panic disorder (PD). The meta‐analysis was performed with PTSD and GAD since PD and SP had an insufficient number of studies and sample sizes. Results Among anxiety and trauma‐related disorders, TMS has been most widely studied as a treatment for PTSD. TMS demonstrated large overall treatment effect for both PTSD (ES = −0.88, 95% CI: −1.42, −0.34) and GAD (ES = −2.06, 95% CI: −2.64, −1.48), including applying high frequency over the right dorsolateral prefrontal cortex. Since few studies have evaluated TMS for SP and PD, few conclusions can be drawn. Conclusions Our meta‐analysis suggests that TMS may be an effective treatment for GAD and PTSD.

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“…Symptom reductions are durable, lasting up to 1‐year posttreatment (Carpenter et al, ; Dunner et al, ). TMS is also an emerging treatment for PTSD (Koek, Roach, Athanasiou, van 't Wout‐Frank, & Philip, ), including comorbid PTSD+MDD (Carpenter et al, ; Philip, Ridout, Albright, Sanchez, & Carpenter, ).…”

Section: Introductionmentioning

confidence: 99%

White matter integrity and functional predictors of response to repetitive transcranial magnetic stimulation for posttraumatic stress disorder and major depression

et al. 2019

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Background: Recent evidence suggests that therapeutic repetitive transcranial magnetic stimulation (TMS) is an effective treatment for pharmacoresistant posttraumatic stress disorder (PTSD) and comorbid major depressive disorder (MDD). We recently demonstrated that response to 5 Hz TMS administered to the dorsolateral prefrontal cortex was predicted by functional connectivity of the medial prefrontal (MPFC) and subgenual anterior cingulate cortex (sgACC). This functionallydefined circuit is a novel target for treatment optimization research, however, our limited knowledge of the structural pathways that underlie this functional predisposition is a barrier to target engagement research.Methods: To investigate underlying structural elements of our previous functional connectivity findings, we submitted pre-TMS diffusion-weighted imaging data from 20 patients with PTSD and MDD to anatomically constrained tract-based probabilistic tractography (FreeSurfer's TRActs Constrained by UnderLying Anatomy). Averaged pathway fractional anisotropy (FA) was extracted from four frontal white matter tracts: the forceps minor, cingulum, anterior thalamic radiations (ATRs), and uncinate fasciculi. Tract FA statistics were treated as explanatory variables in backward regressions testing the relationship between tract integrity and functional connectivity coefficients from MPFC and sgACC predictors of symptom improvement after TMS.Results: FA in the ATRs was consistently associated with symptom improvement in PTSD and MDD (Bonferroni-corrected p < .05). Conclusion:We found that structural characteristics of the ATR account for significant variance in individual-level functional predictors of post-TMS improvement. TMS optimization studies should target this circuit either in stand-alone or successive TMS stimulation protocols. K E Y W O R D S diffusion magnetic resonance imaging, major depressive disorder, posttraumatic stress disorders, transcranial magnetic stimulation, white matter

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5‐Hz Transcranial Magnetic Stimulation for Comorbid Posttraumatic Stress Disorder and Major Depression

Cited by 54 publications

References 26 publications

Predictors of response to synchronized transcranial magnetic stimulation for major depressive disorder

Predictors of response to synchronized transcranial magnetic stimulation for major depressive disorder

Transcranial magnetic stimulation in anxiety and trauma‐related disorders: A systematic review and meta‐analysis

White matter integrity and functional predictors of response to repetitive transcranial magnetic stimulation for posttraumatic stress disorder and major depression

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