Repetitive Transcranial Magnetic Stimulation for the Acute Treatment of Major Depressive Episodes

Brunoni, André R.; Chaimani, Anna; Moffa, Adriano H.; Razza, Laís B.; Gattaz, Wagner F.; Daskalakis, Zafiris J.; Carvalho, André F.

doi:10.1001/jamapsychiatry.2016.3644

Cited by 382 publications

(342 citation statements)

References 110 publications

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“…28 Despite some mixed results (likely in part related to the issues described above), rTMS for medication-resistant depression has shown efficacy in larger trials and the FDA has cleared four different devices for this indication. 46 Furthermore, multiple studies have gone on to show real-world clinical effectiveness 47 and cost effectiveness. 48 Two companies (Nexstim and Neuronix) have recently completed pivotal, premarket approval studies for two new applications of rTMS, motor recovery in stroke rehabilitation 49 and cognitive improvement in Alzheimer’s disease.…”

Section: Implications Of Differential Placebo Effectsmentioning

confidence: 99%

Challenges of differential placebo effects in contemporary medicine: The example of brain stimulation

Burke

Kaptchuk

Pascual‐Leone

2019

Annals of Neurology

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‘Differential placebo effects’ is the concept that different types of placebos (e.g. inert pill versus sham device) may yield different magnitudes of placebo effects. This issue has been pushed into the spotlight by recent clinical trials of new technologies reporting unexpectedly large placebo effects from sham devices/procedures needed to maintain blinding integrity. In this Neurology Grand Rounds, we use transcranial magnetic stimulation as a model to explore the principles and implications of differential placebo effects. We highlight emerging research on the neurobiology of placebo effects and analyze fundamental questions of measuring efficacy in contemporary medicine.

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Section: Implications Of Differential Placebo Effectsmentioning

confidence: 99%

Challenges of differential placebo effects in contemporary medicine: The example of brain stimulation

Burke

Kaptchuk

Pascual‐Leone

2019

Annals of Neurology

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“…Finally, while sham conditions have been used to demonstrate superiority of rTMS relative to placebo (for review, see Brunoni et al, 2017), research studies such ours typically do not include sham due to the ethical difficulties involved. Finally, while sham conditions have been used to demonstrate superiority of rTMS relative to placebo (for review, see Brunoni et al, 2017), research studies such ours typically do not include sham due to the ethical difficulties involved.…”

Section: Limitationsmentioning

confidence: 99%

A multivariate neuroimaging biomarker of individual outcome to transcranial magnetic stimulation in depression

Cash

Cocchi

Anderson

et al. 2019

Human Brain Mapping

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The neurobiology of major depressive disorder (MDD) remains incompletely understood, and many individuals fail to respond to standard treatments. Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) has emerged as a promising antidepressant therapy. However, the heterogeneity of response underscores a pressing need for biomarkers of treatment outcome. We acquired resting state functional magnetic resonance imaging (rsfMRI) data in 47 MDD individuals prior to 5–8 weeks of rTMS treatment targeted using the F3 beam approach and in 29 healthy comparison subjects. The caudate, prefrontal cortex, and thalamus showed significantly lower blood oxygenation level‐dependent (BOLD) signal power in MDD individuals at baseline. Critically, individuals who responded best to treatment were associated with lower pre‐treatment BOLD power in these regions. Additionally, functional connectivity (FC) in the default mode and affective networks was associated with treatment response. We leveraged these findings to train support vector machines (SVMs) to predict individual treatment responses, based on learned patterns of baseline FC, BOLD signal power and clinical features. Treatment response (responder vs. nonresponder) was predicted with 85–95% accuracy. Reduction in symptoms was predicted to within a mean error of ±16% (r = .68, p < .001). These preliminary findings suggest that therapeutic outcome to DLPFC‐rTMS could be predicted at a clinically meaningful level using only a small number of core neurobiological features of MDD, warranting prospective testing to ascertain generalizability. This provides a novel, transparent and physiologically plausible multivariate approach for classification of individual response to what has become the most commonly employed rTMS treatment worldwide. This study utilizes data from a larger clinical study (Australian New Zealand Clinical Trials Registry: Investigating Predictors of Response to Transcranial Magnetic Stimulation for the Treatment of Depression; ACTRN12610001071011; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336262).

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“…In Japan, rTMS was approved as a novel therapy for treatment‐resistant depression in September 2017. Clinical trials and meta‐analyses have demonstrated the efficacy of facilitatory stimulation such as high‐frequency rTMS and intermittent theta burst stimulation (iTBS) over the left prefrontal cortex …”

Section: Introductionmentioning

confidence: 99%

Effectiveness of high‐frequency left prefrontal repetitive transcranial magnetic stimulation in patients with treatment‐resistant depression: A randomized clinical trial of 37.5‐minute vs 18.75‐minute protocol

Kito

Miyazi

Nakatani

et al. 2019

Neuropsychopharm Rep

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Aim Clinical trials and meta‐analyses have demonstrated the efficacy of high‐frequency repetitive transcranial magnetic stimulation (rTMS) over the left prefrontal cortex in treatment‐resistant depression. The aim of this study was to prospectively evaluate the effectiveness of the conventional 37.5‐minute vs 18.75‐minute rTMS protocol over the left prefrontal cortex in patients with treatment‐resistant depressive episode. Methods Thirty patients with treatment‐resistant depression or bipolar disorder depressive episode were randomized 1:1 to either 37.5‐minute or 18.75‐minute rTMS protocol groups. rTMS treatment was applied at 120% resting motor threshold with 10 Hz over the left prefrontal cortex. Treatment sessions were delivered for a total of 3000 pulses/d, 5 days a week, for 4‐6 weeks. Patients received a 75 trains with “4 sec on and 26 sec off” for 37.5 minutes or a 75 trains with “4 sec on and 11 sec off” for 18.75 minutes. Severity of depression was rated with the Quick Inventory of Depressive Symptomatology (QIDS) and Patient Health Questionnaire (PHQ‐9). Remission was defined as a total score of 5 or less on the QIDS. The primary outcome measure was to compare the remission rate between the both groups. Results Thirteen of 30 patients (43.3%) showed remission at week 6. There were no significant differences in the remission rate between the conventional 37.5‐ and 18.75‐minute protocol groups (46.7% and 40.0%, respectively). No seizures or treatment‐emergent mania/hypomania were occurred. Conclusion These findings suggest that, compared with the conventional one, rTMS with 18.75‐minute protocol might be equally effective and clinically beneficial in saving the treatment session length. Further well‐designed studies are needed.

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Repetitive Transcranial Magnetic Stimulation for the Acute Treatment of Major Depressive Episodes

Abstract: clinicaltrials.gov Identifier: PROSPERO CRD42015019855.

Cited by 382 publications

References 110 publications

Challenges of differential placebo effects in contemporary medicine: The example of brain stimulation

Challenges of differential placebo effects in contemporary medicine: The example of brain stimulation

A multivariate neuroimaging biomarker of individual outcome to transcranial magnetic stimulation in depression

Effectiveness of high‐frequency left prefrontal repetitive transcranial magnetic stimulation in patients with treatment‐resistant depression: A randomized clinical trial of 37.5‐minute vs 18.75‐minute protocol

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