scholarly journals Bilateral Sequential Theta Burst Stimulation for Multiple-Therapy-Resistant Depression: a naturalistic observation study

2020 ◽  
Author(s):  
Amer M. Burhan ◽  
James A. Patience ◽  
Johannes G.P. Teselink ◽  
Nicole M. Marlatt ◽  
Sahand Babapoor-Farokhran ◽  
...  
Keyword(s):  
Response Rate ◽  
Remission Rate ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Resistance ◽  
Annual Conference ◽  
Average Response Rate ◽  
Observation Study ◽  
Resting Motor Threshold ◽  
Resistant Depression ◽  
Theta Burst

AbstractDepression is a significant health issue with treatment resistance reported in about one third of patients. Treatment resistance results in significant disability, impaired quality of life, and increased healthcare costs. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for treatment resistant depression (TRD) with an average response rate of around 30%. Theta-burst is a novel rTMS paradigm that has shown promise as a treatment for TRD in some preliminary studies. In a naturalistic design, we evaluated the efficacy and tolerability of bilateral sequential (right then left) prefrontal theta-burst rTMS (bsTBS) in 50 patients with TRD (600 pulses/session, 20 sessions, 100% of resting motor threshold (two patients treated at 80% due to intolerance of 100%), F4/F3 of 10-20-20 EEG localization). Data was collected over 36 months from a specialized academic TMS clinic. Patients had multiple-treatment resistance with at least two failed trials of different antidepressants with 20% also having failed electroconvulsive therapy and 66% having received professional therapy. We found a 28% remission rate (HAMD-17 score of ≤ 7) and a 52% response rate (≥ 50% reduction in HAMD-17) with a 42% reduction in average HAMD-17 score. The treatment was well tolerated, with muscle contractions, mild pain or discomfort, headache, scalp irritation, and changes to vitals being captured as occasional adverse events with two instances of syncope (0.22% of treatments). This naturalistic study shows that bsTBS is a promising paradigm for a multiple-TRD patient population with approximately one-third of treatments achieving remission and over half achieving significant response.Previous PublicationAbstract accepted and study presented at the 2018 Canadian Psychiatric Association Annual Conference, Toronto, Ontario, Canada, September 29, 2018.

scholarly journals Treatment of major depressive disorder with bilateral theta burst stimulation: study protocol for a randomized, double-blind, placebo-controlled multicenter trial (TBS-D)

2021 ◽  
Author(s):  
Christian Plewnia ◽  
Bettina Brendel ◽  
Tobias Schwippel ◽  
Vanessa Nieratschker ◽  
Thomas Ethofer ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Rating Scale ◽  
Treatment Time ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Major Depressive ◽  
Resting Motor Threshold ◽  
Theta Burst

AbstractRepetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (dlPFC) is currently evolving as an effective and safe therapeutic tool in the treatment of major depressive disorder (MDD). However, already established rTMS treatment paradigms are rather time-consuming. With theta burst stimulation (TBS), a patterned form of rTMS, treatment time can be substantially reduced. Pilot studies and a randomized controlled trial (RCT) demonstrate non-inferiority of TBS to 10 Hz rTMS and support a wider use in MDD. Still, data from placebo-controlled multicenter RCTs are lacking. In this placebo-controlled multicenter study, 236 patients with MDD will be randomized to either intermittent TBS (iTBS) to the left and continuous TBS (cTBS) to the right dlPFC or bilateral sham stimulation (1:1 ratio). The treatment will be performed with 80% resting motor threshold intensity over six consecutive weeks (30 sessions). The primary outcome is the treatment response rate (Montgomery-Asberg Depression Rating Scale reduction ≥ 50%). The aim of the study is to confirm the superiority of active bilateral TBS compared to placebo treatment. In two satellite studies, we intend to identify possible MRI-based and (epi-)genetic predictors of responsiveness to TBS therapy. Positive results will support the clinical use of bilateral TBS as an advantageous, efficient, and well-tolerated treatment and pave the way for further individualization of MDD therapy.Trial registration: ClinicalTrials.gov (NCT04392947).

Comparative Efficacy and Acceptability of 3 Repetitive Transcranial Magnetic Stimulation Devices for Depression: A Meta-Analysis of Randomized, Sham-Controlled Trials

2021 ◽  
pp. 1-9
Author(s):  
Yuki Matsuda ◽  
Ryuichi Yamazaki ◽  
Taro Kishi ◽  
Nakao Iwata ◽  
Masahiro Shigeta ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Depressive Disorders ◽  
Remission Rate ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Similar Efficacy ◽  
Controlled Trials ◽  
Resistant Depression ◽  
Therapy Resistant Depression

<b><i>Introduction:</i></b> Repetitive transcranial magnetic stimulation (rTMS) has been employed worldwide for therapy-resistant depression. The Food and Drug Administration has approved a number of therapeutic devices for treating major depressive disorder; however, no studies have examined the differences in efficacy and acceptability among commercially available stimulation devices. The aim of our study was to compare the efficacy and acceptability of 3 stimulation devices (NeuroStar, MagPro, and Magstim) for depressive disorders. <b><i>Methods:</i></b> Our study included 31 randomized sham-controlled trials of high-frequency rTMS included in the network meta-analysis by Brunoni. We calculated the risk ratio and 95% confidence intervals, comparing each device with sham for the endpoints of response rate, remission rate, and all-cause discontinuation. We then analyzed the differences among the devices in effect size for those endpoints. <b><i>Results:</i></b> After determining the effect sizes for the endpoints, we found no statistically significant subgroup differences in the response rates, all-cause discontinuation, or remission rates among the devices (<i>p</i> = 0.12, <i>p</i> = 0.84, and <i>p</i> = 0.07, respectively). <b><i>Conclusion:</i></b> Our results suggest similar efficacy and acceptability for the 3 stimulation devices. Future studies need to perform head-to-head comparisons of the efficacy and acceptability of the stimulation devices for treating depression using the same stimulation protocols.

scholarly journals Repetitive transcranial magnetic stimulation in non-treatment-resistant depression

2019 ◽  
Vol 215 (2) ◽  
pp. 445-446 ◽  
Author(s):  
Maximilian Kiebs ◽  
René Hurlemann ◽  
Julian Mutz
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Treatment Resistance ◽  
Major Depressive ◽  
Resistant Depression ◽  
Using Data ◽  
Major Depressive Episodes ◽  
Depressive Episodes

SummaryRepetitive transcranial magnetic stimulation (rTMS) has been investigated as treatment for major depressive episodes since the early 1990s. Using data from a recent meta-analysis, we show that most patients included in randomised trials display relatively high degrees of treatment resistance. This might have unfavourably biased the clinical reputation of rTMS.Declaration of interestsM.K. has received a lecture fee from Innomed Medizintechnik in 2017 and 2018.

scholarly journals Bilateral sequential theta burst stimulation for multiple-therapy-resistant depression: A naturalistic observation study

2020 ◽  
Vol 130 ◽  
pp. 342-346
Author(s):  
Amer M. Burhan ◽  
James A. Patience ◽  
Johannes G.P. Teselink ◽  
Nicole M. Marlatt ◽  
Sahand Babapoor-Farrokhran ◽  
...  
Keyword(s):  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Naturalistic Observation ◽  
Observation Study ◽  
Resistant Depression ◽  
Therapy Resistant Depression ◽  
Theta Burst ◽  
Multiple Therapy

Effect of antipsychotic pharmacotherapy on clinical outcomes of intermittent theta-burst stimulation for refractory depression

2016 ◽  
Vol 31 (3) ◽  
pp. 312-319 ◽  
Author(s):  
Laura Schulze ◽  
Gary Remington ◽  
Peter Giacobbe ◽  
Sidney H Kennedy ◽  
Daniel M Blumberger ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Clinical Outcomes ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Resistant Depression ◽  
Theta Burst Stimulation ◽  
Treatment Resistant ◽  
Burst Stimulation ◽  
Resistant Depression ◽  
Theta Burst

Theta-burst stimulation is an emerging protocol for repetitive transcranial magnetic stimulation that takes 1–3 min to administer, yet offers equal/superior potency to conventional protocols lasting 30–60 min. However, preclinical evidence suggests that D2 receptor blockade may abolish the acute effects of theta-burst stimulation on synaptic facilitation or inhibition. As many patients presenting for repetitive transcranial magnetic stimulation are taking antipsychotic medications as augmentation for treatment-resistant depression, this finding is potentially concerning for the implementation of theta-burst stimulation in clinical settings. Here, we examined whether treatment-resistant depression patients taking antipsychotics have worse outcomes after a course of intermittent theta-burst stimulation. A chart review identified 105 treatment-resistant depression patients who underwent dorsomedial prefrontal-intermittent theta-burst stimulation; clinical outcomes on Hamilton Depression Rating Scale and Beck Depression Inventory were compared for those taking and not taking antipsychotics. The 29 of 105 patients who were taking antipsychotics showed non-significantly better response and remission rates, and non-significantly larger percentage improvements on both scales, with a positive but non-significant correlation between higher antipsychotic dose and larger percentage improvement. Contrary to expectations, outcomes were not significantly worse, and in some analyses trended towards being better, in patients taking antipsychotics. Future randomized controlled studies of repetitive transcranial magnetic stimulation combined with standardized dopaminergic manipulations may be justified and warranted.

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