Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study

Blumberger, Daniel M.; Maller, Jerome Joseph; Thomson, Lauren; Mulsant, Benoit H.; Rajji, Tarek K.; Maher, Missy; Brown, Patrick; Downar, Jonathan; Vila‐Rodriguez, Fidel; Fitzgerald, Paul B.; Daskalakis, Zafiris J.

doi:10.1503/jpn.150265

Cited by 86 publications

(84 citation statements)

References 49 publications

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“…Participants were recruited at an urban tertiary mental health center (Centre for Addiction and Mental Health, Toronto, Ontario, Canada). The complete details of the inclusion criteria are available in the original published studies, ClinicalTrials.gov IDs NCT00305045 and NCT01515215 . The present study included data obtained from participants who were between the ages of 60 and 85, meeting criteria for a major depressive episode without psychotic features (as diagnosed by SCID‐IV‐TR), a score above 19 on the 17‐item Hamilton‐Depression Rating Scale (HDRS), nonresponse or intolerability of two antidepressant trials (across separate classes and at adequate doses), and were on four or more weeks of a stable dose of all psychotropic medication preceding randomization.…”

Section: Methodsmentioning

confidence: 99%

“…Stimulation was applied at intensities drawn from previously published protocols . In one of the contributing clinical trials, stimulation intensity was adjusted for coil‐to‐cortex distance, specifically at 120% of the distance‐adjusted resting motor threshold . Participants in the other trial received stimulation at 120% of the RMT unadjusted for coil‐to‐cortex distance .…”

Section: Methodsmentioning

confidence: 99%

“…Participants in the other trial received stimulation at 120% of the RMT unadjusted for coil‐to‐cortex distance . Localizing the DLPFC was determined either as 5‐cm anterior to the site of maximal stimulation of the abductor pollicis brevis (study 1) or through MRI (magnetic resonance imaging) neuronavigation (study 2). Treatment parameters, outlined in Table , were in accordance with safety guidelines.…”

Section: Methodsmentioning

confidence: 99%

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Unilateral and bilateral repetitive transcranial magnetic stimulation for treatment‐resistant late‐life depression

Trevizol

Goldberger

Mulsant

et al. 2019

Int J Geriat Psychiatry

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Background: The management of late-life depression is challenged by high rates of treatment-resistance and adverse effects, along with medical comorbidities and polypharmacy. Together with the limited data on managing treatment-resistant depression in older adults, there is a need for investigating the efficacy of nonpharmacological treatment strategies. Repetitive transcranial magnetic stimulation (rTMS) is one modality that may better serve this patient population.Methods: The present study examines data from two previous clinical trials (NCT00305045 and NCT01515215) to explore the efficacy of bilateral and unilateral high-frequency left-sided (HFL) rTMS in older adults suffering from treatmentresistant depression. A total of 43 adults aged 60 or older with a current major depressive episode were randomized to bilateral sequential, unilateral HFL, or sham.Bilateral sequential stimulation involved low-frequency (1 Hz) right dorsolateral prefrontal cortex (DLPFC) stimulation followed immediately by high-frequency (10 Hz) left DLPFC. The unilateral condition was HFL stimulation alone, and the placebo condition was either HFL or sequential bilateral form of sham. The primary outcome was remission of depression.Results: Participants receiving bilateral rTMS experienced greater remission rates (40%) compared with unilateral (0%) or sham (0%) groups. Response to rTMS in the Hamilton Depression Rating Scale scores similarly favored the efficacy of bilateral rTMS. Conclusion:This study suggests that sequential bilateral treatment may be an optimal form of rTMS when used for treatment-resistant depression in older adults.Further large-scale comparative effectiveness trials of bilateral rTMS in this population are warranted.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Unilateral and bilateral repetitive transcranial magnetic stimulation for treatment‐resistant late‐life depression

Trevizol

Goldberger

Mulsant

et al. 2019

Int J Geriat Psychiatry

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“…However, the proportion of patients who missed one or more sessions was not described. Finally, Levkovitz et al (2015) reported in the study flowchart that two participants were excluded from the study after missing two sessions [27]. No further details were described.…”

Section: Findings' Summarymentioning

confidence: 99%

“…In the present review, we noticed that most RCTs did not report missed visits and less than 10% of the RCTs reviewed clearly stated how these missed visits were managed when they occurred. We proposed a plan to handle this issue by allowing up to 20% of appointments to be missed and replacing those visits at the end of the designated stimulations period as successfully done in several RCTs [20,21,27,48]. This method seems to have an appropriate balance between the rigor required in RCT and the flexibility needed for patients with depression or chronic pain, or other conditions inclined to missed treatment visits.…”

Section: Expert Commentarymentioning

confidence: 99%

Strategies for replacing non-invasive brain stimulation sessions: recommendations for designing neurostimulation clinical trials

Thibaut

O’Brien

Fregni

2017

Expert Review of Medical Devices

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Introduction: Despite the potential impact of missed visits on the outcomes of neuromodulation treatments, it is not clear how this issue has been addressed in clinical trials. Given this gap in the literature, we reviewed articles on non-invasive brain stimulation in participants with depression or chronic pain, and investigated how missed visits were handled. Areas covered:We performed a search on PUBMED/MEDLINE using the keywords: "tDCS", "transcranial direct current stimulation", "transcranial magnetic stimulation¨, "depression", and "pain". We included studies with a minimum of five participants who were diagnosed with depression or chronic pain, who underwent a minimum of five tDCS or TMS sessions. A total of 181 studies matched our inclusion criteria, 112 on depression and 69 on chronic pain. Of these, only fifteen (8%) articles reported or had a protocol addressing missed visits. This review demonstrates that, in most of the trials, there is no reported plan to handle missed visits.Expert commentary: Based on our findings and previous studies, we developed suggestions on how to handle missed visits in neuromodulation protocols. A maximum of 20% of missing sessions should be allowed before excluding a patient and these sessions should be replaced at the end of the stimulation period.

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Association of Repetitive Transcranial Magnetic Stimulation Treatment With Subgenual Cingulate Hyperactivity in Patients With Major Depressive Disorder

et al. 2019

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Key Points Question Is repetitive transcranial magnetic stimulation associated with changes in subgenual cingulate cortex (SGC) activity in patients with major depressive disorder (MDD)? Findings This diagnostic study, which compared 30 patients with MDD and 30 healthy controls, found that using transcranial magnetic stimulation combined with electroencephalography, SGC activity in patients with MDD was significantly higher compared with healthy controls. After active repetitive transcranial magnetic stimulation, SGC hyperactivity in patients with MDD was attenuated toward the levels of healthy controls. Meaning These SGC-localized findings support SGC hyperactivity as a central construct in the pathophysiology of MDD, which future work might develop into a clinically significant biological target.

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Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study

Cited by 86 publications

References 49 publications

Unilateral and bilateral repetitive transcranial magnetic stimulation for treatment‐resistant late‐life depression

Unilateral and bilateral repetitive transcranial magnetic stimulation for treatment‐resistant late‐life depression

Strategies for replacing non-invasive brain stimulation sessions: recommendations for designing neurostimulation clinical trials

Association of Repetitive Transcranial Magnetic Stimulation Treatment With Subgenual Cingulate Hyperactivity in Patients With Major Depressive Disorder

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