5Hz Repetitive transcranial magnetic stimulation to left prefrontal cortex for major depression

Abstract

Background Repetitive transcranial magnetic stimulation (rTMS) to left prefrontal cortex at 10 Hz is the most commonly utilized protocol for major depressive disorder (MDD). Published data suggests that left sided 5 Hz rTMS may be efficacious and well tolerated. Objective We analyzed outcomes in a naturalistic cohort of MDD patients who could not tolerate 10 Hz rTMS and were routinely switched to 5 Hz. We hypothesized that the efficacy of 5 Hz rTMS would be equivalent to 10 Hz. Methods Records were reviewed for patients (n=98) who received 15 or more acute rTMS treatments. The sample was split based upon the frequency (10 or 5 Hz) at which the majority of treatments were delivered. The Inventory of Depressive Symptoms (IDS-SR) and 9-Item Patient Health Questionnaire (PHQ-9) were used to evaluate outcomes. Results Baseline IDS-SR was higher in the 5 Hz (n=27) than in the 10 Hz (n=71) group (p < .05), as was frequency of comorbid anxiety (p = .002). Depression outcomes did not differ between groups, and there were no differences in response or remission rates (all p > .1). Statistical power was sufficient to detect small group differences (d = .26). Limitations Open-label data in a naturalistic setting. Conclusion Outcomes associated with 5 Hz rTMS did not differ from 10 Hz, despite higher baseline depressive symptom severity and anxiety in 5 Hz patients. 5 Hz stimulation may be an alternative treatment option for patients unable to tolerate 10 Hz rTMS.

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

“…Although we recognize that outcomes in an open‐label case series should be interpreted with caution, these data suggested that 5‐Hz rTMS appeared to reduce symptoms of MDD and PTSD, and suggested 5 Hz may be well suited for this comorbidity. The outcomes reported here were consistent with our prior experience with 5 Hz in patients with MDD with comorbid anxiety (Philip et al., ), which found this parameter was efficacious in reducing symptoms in a patient population with an otherwise poor prognosis for clinical response.…”

“…We recently described our clinical experience with left‐sided 5 Hz for the treatment of MDD, and confirmed efficacy of 5 Hz versus standard 10 Hz in severely depressed patients ( g = 1.95; Philip et al., ). This pulse frequency was chosen based on the literature above, to incorporate potential benefits of improved tolerability and reduced seizure risk compared to higher frequency stimulation.…”

Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients

“…The NeuroStar TMS Therapy system (Neuronetics, Inc., Malvern, PA) was used to deliver high-frequency (5 Hz or 10 Hz; Philip et al, 2015) stimulation over left DLPFC, typically with a schedule of 5 TMS sessions per week for 6 weeks, followed by 6 additional treatments in a taper schedule over three weeks. If remission was achieved prior to treatment number 30, the taper phase would begin earlier.…”

Do bipolar disorder soft signs impact outcomes following Transcranial Magnetic Stimulation (TMS) therapy for depression?

“…While the majority of studies report TMS is safe for bipolar depression (Fitzgerald et al, 2016;Hu et al, 2016;Nahas et al, 2003), some suggest TMS may induce mood destabilization (Dolberg et al, 2001), and we previously reported TMS-associated activation (emergence of insomnia, irritability, anxiety, or agitation) among patients with primary unipolar major depression (Philip et al, 2015). Additionally, there may be some risk of induced manic or hypomanic episodes in patients with bipolar disorder treated with repetitive TMS (Rachid, 2017).…”