Utility of Repetitive Transcranial Stimulation as an Augmenting Treatment Method in Treatment-Resistant Depression

Abstract

About 30 to 46% of patients with major depressive disorder (MDD) fail to fully respond to initial antidepressants. Treatment-resistant depression (TRD) is a severely disabling disorder with no proven treatment options; novel treatment methods like rTMS can be used as augmentation to ongoing pharmacotherapy or as a solitary method of treatment. To evaluate the utility of repetitive transcranial magnetic stimulation as an augmenting method in TRD. In an open-label study, 21 patients with DSM-IV MDD without psychotic features who had failed to respond to an adequate trial of at least 2 antidepressants were given rTMS therapy for 4 weeks, keeping the dose of pre-existing antidepressants unchanged. High-frequency (10 Hz) stimulations were delivered over left dorsolateral prefrontal cortex at intensity of 110% of patient's motor threshold. Treatment response was defined as a reduction in score on the Hamilton Rating Scale for Depression (HAM-D) from baseline to end of treatment. Secondary efficacy measures included scores on the Clinical Global Impressions-Change and -Severity scales. At the end of 4 weeks, 19 patients completed the 4-week study and were assessed. In ITT analysis, the mean HAM-D17 scores were reduced from 30.80±5.00 to 19.00±6.37 (t=8.27, P<0.001). Only four patients reported headache, but there was no discontinuation due to adverse effects. The study indicates the potential utility of rTMS as an augmenting agent in TRD. Adequately powered, randomized controlled trials are necessary to evaluate the role of rTMS in TRD.

Treatment-resistant depression: therapeutic trends, challenges, and future directions

“…Both high frequency left-sided and low frequency right-sided unilateral rTMS are efficacious in treatment-resistant depression. Similar benefits have been suggested for sequential bilateral rTMS (low frequency right-sided then high frequency left-sided) 113. In another study, subjects aged 18–85 years were recruited from a tertiary care university hospital.…”

The Combination of Antidepressant Drug Therapy and High-Frequency Repetitive Transcranial Magnetic Stimulation in Medication-Resistant Depression

“…In recent studies, high frequency (10 Hz) rTMS delivered at 110% MT over the left DLPFC was reported to cause significant decreases in HAMD scores with a 4-week treatment (43). Although we applied high frequency rTMS over the left DLPFC, in recent studies it has been reported that this administration has similar effects to low frequency administration over the right DLPFC (44).…”

Risk of seizures in transcranial magnetic stimulation: a clinical review to inform consent process focused on bupropion

“… 1 rTMS can be used in monotherapy as well as in combination with antidepressant medications, particularly when facing treatment-resistant depression. 2 In this regard, during the assessment and consent process, clinicians and patients still face important questions with regard to the interaction of pharmacological interventions with rTMS, specifically in terms of safety of the combined intervention. When discussing medications and potential hazards for rTMS, current guidelines on use of rTMS establish a categorization of medications that can pose a potential hazard for rTMS.…”