An Open Label Trial of Clustered Maintenance rTMS for Patients with Refractory Depression

Fitzgerald, Paul B.; Grace, Nicci; Hoy, Kate Elizabeth; Bailey, Michael; Daskalakis, Zafiris J.

doi:10.1016/j.brs.2012.05.003

Cited by 51 publications

(28 citation statements)

References 15 publications

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“…Design Outcome O'Reardon et al, 2005 [12] Retrospective, N = 10, followed 6 months to 6 years 7/10 received moderate or marked benefit; 3/10 maintained on TMS monotherapy Connolly et al, 2012 [13] Retrospective, N = 42, followed for 6 months 62% maintained improvements Fitzgerald et al, 2013 [14] Prospective, N = 35, monthly series of 5 treatments over two days Delayed relapse by 6-12 months Richieri et al, 2013 [15] Prospective, N = 59, extended taper phase after acute TMS 38% relapse for maintenance group compared to 82% with no maintenance Harel et al, 2014 [16] Prospective Number of participants indicates those followed in continuation/maintenance phase.…”

Section: Studymentioning

confidence: 99%

“…Over 6 months, 62% maintained their level of depressive symptom relief. Fitzgerald et al [14] conducted a prospective trial of monthly clustered TMS maintenance sessions (5 treatments delivered over two days) in 35 patients who responded to two prior acute courses of TMS. This approach substantially delayed the onset of relapse, relative to the duration of wellness following patients' prior acute TMS series.…”

Section: Introductionmentioning

confidence: 99%

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Can Medication Free, Treatment-Resistant, Depressed Patients Who Initially Respond to TMS Be Maintained Off Medications? A Prospective, 12-Month Multisite Randomized Pilot Study

et al. 2016

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Section: Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can Medication Free, Treatment-Resistant, Depressed Patients Who Initially Respond to TMS Be Maintained Off Medications? A Prospective, 12-Month Multisite Randomized Pilot Study

et al. 2016

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“…In addition, rTMS has a superior tolerability profile and does not adversely effect cognition (13). Though there are relatively few studies that have examined maintenance of response after an acute course of rTMS, emerging data suggests that a schedule of clustered treatments can maintain response in those that have responded to an acute course of rTMS (28). …”

Section: Introductionmentioning

confidence: 99%

Repetitive Transcranial Magnetic Stimulation to Maintain Treatment Response to Electroconvulsive Therapy in Depression: A Case Series

2013

Self Cite

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Electroconvulsive therapy (ECT) is the most effective treatment for a refractory major depression in the context of both unipolar and bipolar affective disorders. However, the relapse rate within the first 6 months after a successful course of ECT to treat a depressive episode can be as high 50%. Evidence-based strategies to prevent relapse have partial efficacy and are associated with problematic adverse effects limiting their use as long-term treatments. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in treatment-resistant depression with a favorable adverse effect profile. Herein, we describe six patients, four with unipolar and two with bipolar depression, where rTMS was used to maintain response after a successful course of acute and continuation ECT. rTMS was administered once or twice weekly, at 120% of the resting motor threshold. Patients received sequential bilateral rTMS (low frequency right: 600 pulses, then high frequency left: 3000 pulses). The site of stimulation was 6 cm anterior and 1 cm lateral from the site of maximum stimulation of the abductor pollicis brevis muscle. Depressive symptoms were monitored with the quick inventory of depressive symptoms-self rated. Five of the six patients were able to maintain their response status from 6 to 13 months at the time of last observation. The use of rTMS may be an important relapse prevention strategy following an acute course of ECT. Controlled studies comparing rTMS to current evidence-based relapse prevention strategies are warranted.

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“…To be in naturalistic conditions, baseline pharmacological treatments are maintained during the study, especially given the fact that adjuvant rTMS has the potential to increase the efficacy of antidepressant treatments [71]. It is now time to investigate the efficiency and health economic characteristics of these different therapeutic strategies in TRD, including add-on curative and maintenance rTMS versus TAU.…”

Section: Discussionmentioning

confidence: 99%

Cost-utility analysis of curative and maintenance repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant unipolar depression: a randomized controlled trial protocol

Bulteau

Laurin

Volteau

et al. 2020

Trials

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Background: Depression is a debilitating and costly disease for our society, especially in the case of treatmentresistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant therapy in treatment-resistant unipolar and non-psychotic depression. It can be applied according to two therapeutic strategies after an initial rTMS cure: a further rTMS cure can be performed at the first sign of relapse or recurrence, or systematic maintenance rTMS (M-rTMS) can be proposed. TMS adjuvant to treatment as usual (TAU) could improve long-term prognosis. However, no controlled study has yet compared the cost-effectiveness of these two additional rTMS therapeutic strategies versus TAU alone. Methods/design: This paper focuses on the design of a health-economic, prospective, randomized, double-blind, multicenter study with three parallel arms carried out in France. This study assesses the cost-effectiveness of the adjunctive and maintenance low frequency rTMS on the right dorsolateral prefrontal cortex versus TAU alone. A total of 318 patients suffering from a current TRD will be enrolled. The primary endpoint is to investigate the incremental cost-effectiveness ratio (ICER) (ratio costs / quality-adjusted life-years [QALY] measured by the Euroqol Five Dimension Questionnaire) over 12 months in a population of patients assigned to one of three arms: systematic M-rTMS for responders (arm A); additional new rTMS cure in case of mood deterioration among responders (arm B); and a placebo arm (arm C) in which responders are allocated in two subgroups: sham systematic M-rTMS and supplementary rTMS course in case of mood deterioration. ICER and QALYs will be compared between arm A or B versus arm C. The secondary endpoints in each three arms will be: ICER at 24 months; the cost-utility ratio analysis at 12 and 24 months; 5-year budget impact analysis; and prognosis factors of

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An Open Label Trial of Clustered Maintenance rTMS for Patients with Refractory Depression

Cited by 51 publications

References 15 publications

Can Medication Free, Treatment-Resistant, Depressed Patients Who Initially Respond to TMS Be Maintained Off Medications? A Prospective, 12-Month Multisite Randomized Pilot Study

Can Medication Free, Treatment-Resistant, Depressed Patients Who Initially Respond to TMS Be Maintained Off Medications? A Prospective, 12-Month Multisite Randomized Pilot Study

Repetitive Transcranial Magnetic Stimulation to Maintain Treatment Response to Electroconvulsive Therapy in Depression: A Case Series

Cost-utility analysis of curative and maintenance repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant unipolar depression: a randomized controlled trial protocol

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