Real world transcranial magnetic stimulation for major depression: A multisite, naturalistic, retrospective study

Bouaziz, Noomane; Laidi, Charles; Bulteau, Samuel; Berjamin, Caroline; Thomas, Fanny; Moulier, Virginie; Benadhira, René; Szekely, David; Poulet, Emmanuel; Galvão, Filipe; Guillin, Olivier; Castillo, Marie-Carmen; Sauvaget, Anne; Plaze, Marion; Januel, Dominique; Rothärmel, Maud

doi:10.1016/j.jad.2023.01.070

Cited by 12 publications

(9 citation statements)

References 72 publications

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“…This study highlights several important points. Firstly, the percentages of response and remission were relatively similar to what is usually found in the literature and other real-world studies [23], with a 30% remission rate and a 30% response rate. The number of partial responders, on the other hand, seemed to be higher in our sample.…”

Section: Discussionsupporting

confidence: 86%

Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications

Bourla,

Mouchabac,

Lorimy

et al. 2023

Brain Sciences

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The measurement of the motor threshold (MT) is an important element in determining stimulation intensity during Transcranial Magnetic Stimulation treatment (rTMS). The current recommendations propose its realization at least once a week. The variability in this motor threshold is an important factor to consider as it could translate certain neurophysiological specificities. We conducted a retrospective naturalistic study on data from 30 patients treated for treatment-resistant depression in an rTMS-specialized center. For each patient, weekly motor-evoked potential (MEP) was performed and several clinical elements were collected as part of our clinical interviews. Regarding response to treatment (Patient Health Questionnaire-9 (PHQ-9) before and after treatment), there was a mean difference of −8.88 (−21 to 0) in PHQ9 in the Theta Burst group, of −9.00 (−18 to −1) in the High-Frequency (10 Hz) group, and of −4.66 (−10 to +2) in the Low-Frequency (1 Hz) group. The mean improvement in depressive symptoms was 47% (p < 0.001, effect-size: 1.60). The motor threshold changed over the course of the treatment, with a minimum individual range of 1 point and a maximum of 19 points (total subset), and a greater concentration in the remission group (4 to 10) than in the other groups (3 to 10 in the response group, 1 to 8 in the partial response group, 3 to 19 in the stagnation group). We also note that the difference between MT at week 1 and week 6 was statistically significant only in the remission group, with a different evolutionary profile showing an upward trend in MT. Our findings suggest a potential predictive value of MT changes during treatment, particularly an increase in MT in patients who achieve remission and a distinct “break” in MT around the 4th week, which could predict nonresponse.

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Section: Discussionsupporting

confidence: 86%

Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications

Bourla,

Mouchabac,

Lorimy

et al. 2023

Brain Sciences

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“…In conclusion, our work potentially adds further support to studies suggesting the effectiveness of liTBS and bsTBS to safely reduce depressive and anxious symptoms in the naturalistic setting. 11,6–7 Our study extends recent findings from Bouaziz et al (2023) 11 by presenting outcomes from both unilateral and bilateral TBS paradigms, offering multiple outcome measures, and utilizing SEM to account for statistical artifacts such as regression to the mean. The findings also introduce observations of longer-term TBS outcomes in the naturalistic setting.…”

Section: Discussionsupporting

confidence: 70%

“…28 Our post-treatment results serve to partially extend the findings of recent multicentre studies, by highlighting the extent of long-term TBS outcomes in the naturalistic setting. 11…”

Section: Discussionmentioning

confidence: 99%

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Unilateral and Bilateral Theta Burst Stimulation for Treatment-Resistant Depression: Follow up on a Naturalistic Observation Study

Elnazali,

Veerakumar,

Blair

et al. 2024

Preprint

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Background: Theta burst stimulation (TBS) is a novel and faster modality of transcranial magnetic stimulation, which is showing promise as a treatment-resistant depression (TRD) treatment. Though TBS can be applied unilaterally or bilaterally, few studies have compared the effectiveness of both approaches in a naturalistic clinical sample. Objectives: In this retrospective chart review, we aimed to: (1) replicate previous bilateral sequential TBS effectiveness in a larger cohort of patients at a single centre, (2) present treatment outcome data between unilateral and bilateral TBS approaches, (3) investigate baseline factors associated with our observed outcomes, and (4) examine the sustainability of response, with follow-up data up to 6 months from patients. Methods: We included 161 patients who received TBS (unilateral: n = 64 (40%), 45.55 ± 14.25 years old, 55% females; bilateral: n = 97 (60%), 47.67 ± 15.11 years old, 58% females). Results: Firstly, we observed 47% response and 34% remission in the bilateral group, replicating findings from a smaller naturalistic study from our group; patients receiving unilateral TBS displayed 36% response and 26% remission, with no significant differences found between unilateral and bilateral TBS in remission and response rates. Secondly, bilaterally stimulated patients needed fewer treatments than those stimulated unilaterally (27 vs 29 on average respectively, t [159] = 3.31, p = .001), and had significantly lower anxiety symptoms post treatment (GAD-7) relative to patients receiving unilateral stimulation, F (1,148) = 3.95, p =0.049. Thirdly, no baseline factors were found to predict treatment outcomes. Lastly, after six months, 69% of patients who met the response criteria did not require additional treatment or a change in medication. Conclusions: Our findings support the efficacy and tolerability of TBS in TRD and indicate that bilateral TBS may have a superior anxiolytic effect and offer a slightly faster time to response.

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“…In 2008, the United States Food and Drug Administration (FDA) approved rTMS as a standard therapy for TRD. 4 rTMS mainly targets the dorsolateral prefrontal cortex, a region with reduced activity based on functional brain imaging findings. 5 Its waves lead to an rTMS‐induced release of endogenous dopamine and serotonin neurotransmitters in prefrontal cortical areas and have been reported to improve depressive symptoms in affected people.…”

Section: Introductionmentioning

confidence: 99%

Effects of routine repetitive transcranial magnetic stimulation on the sleep duration of patients with treatment‐resistant depression: A prospective cohort study

Sadeghniiat,

Zebardast,

Parsaei

et al. 2024

PCN Reports

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AimThe aim of this study was to evaluate the short‐term and long‐term effects of routine repetitive transcranial magnetic stimulation (rTMS) on the sleep duration, depressive symptoms, and quality of life of patients with treatment‐resistant depression (TRD).MethodsIn this prospective cohort study, 25 participants with TRD were assessed using the Insomnia Severity Index (ISI) and four sleep duration components of the Pittsburgh Sleep Quality Index (PSQI). Depression severity was measured with Hamilton's Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI‐II), and patient‐perceived quality of life with the 36‐Item Short‐Form Survey (SF‐36). All of these measures were evaluated at baseline (T0), and immediately (T1), 6 weeks (T2), and 12 weeks (T3) after the end of intervention.ResultsAt T1 endpoint, HDRS, BDI, SF‐36, ISI, and three PSQI items (time to wake up, time taken to fall asleep, and Real Sleep Time) significantly improved, though these gains were reduced at follow‐up endpoints (T2 and T3). Adjusting for confounders (age, sex, occupational status, BMI, and hypnotic medication) revealed that only improvements in HDRS, BDI, and time taken to fall asleep at T1 remained statistically significant. Linear regression analyses showed no significant association between reduced time taken to fall asleep and depression symptoms, suggesting rTMS can independently enhance this parameter, irrespective of depression resolution.ConclusionRoutine rTMS therapy can potentially enhance sleep duration in TRD individuals, alongside improved depressive symptoms and quality of life. However, these benefits tend to decrease over long‐term follow‐up, emphasizing a more pronounced short‐term efficacy of rTMS.

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Real world transcranial magnetic stimulation for major depression: A multisite, naturalistic, retrospective study

Cited by 12 publications

References 72 publications

Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications

Variability in Motor Threshold during Transcranial Magnetic Stimulation Treatment for Depression: Neurophysiological Implications

Unilateral and Bilateral Theta Burst Stimulation for Treatment-Resistant Depression: Follow up on a Naturalistic Observation Study

Effects of routine repetitive transcranial magnetic stimulation on the sleep duration of patients with treatment‐resistant depression: A prospective cohort study

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