Repetitive transcranial magnetic stimulation in combination with citalopram in young patients with first-episode major depressive disorder: A double-blind, randomized, sham-controlled trial

Background: Studies have implicated hypofrontality in the pathogenesis of impaired theory of mind (ToM) and executive function (EF) in major depressive disorder (MDD). These symptoms are usually resistant to treatment. Repetitive transcranial magnetic stimulation (rTMS) has been shown to reverse hypofrontality. Moreover, BDNF is an effective biomarker of antidepressant effects, but there have been very few studies on the correlation between BDNF and rTMS. We aimed to evaluate the efficacy of 20 sessions of a 10 Hz unilateral rTMS intervention over the left dorsolateral prefrontal cortex (DLPFC) in improving ToM and EF in patients with MDD and its correlation with BDNF. Methods: A total of 120 MDD patients were enrolled in this randomized, sham-controlled, double-blind trial. Each participant received 20 sessions of rTMS at 10 Hz frequency through the active or the sham coil over 4 weeks. ToM was assessed with the facial emotion identification test (FEIT) and hinting task (HT). EF was assessed with the Wisconsin card sorting test (WCST). BDNF assessments were carried out at baseline and 2-, 4-, 12-, and 24-week follow-ups. Results: The improvement in the ToM (FEIT, HT) in the active rTMS group was significantly different from that in the sham rTMS group (F = 18.09, p < 0.001; F = 5.02, p = 0.026). There were significant differences in the WCST (categories completed, response errors, response perseverative errors, non-response perseverative errors) after logarithmic transformation at different time points in the active rTMS group (F = 14.71, p < 0.001; F = 5.99, p = 0.046; F = 8.90, p = 0.031; F = 2.31, p = 0.048). However, there was no significant difference in log transformed BDNF concentration between the two groups (t = 0.07 to t = 1.29, p > 0.05). BDNF was negatively correlated with WCST categories completed at the 24th week (r = −0.258, p = 0.046). Conclusions: The results show that rTMS may improve the ToM and EF of patients with MDD and there was no significant correlation with serum BDNF concentration. RTMS can not only be used for treatment of patients with MDD but also has a positive effect on ToM and EF.

Download Full-text

Repetitive Transcranial Magnetic Stimulation Combined with Antidepressants for the First Episode of Major Depressive Disorder

Current Neuropharmacology ◽

10.2174/1570159x18666200221113134 ◽

2020 ◽

Vol 18 (9) ◽

pp. 852-860 ◽

Cited By ~ 1

Author(s):

Benchalak Maneeton ◽

Narong Maneeton ◽

Pakapan Woottiluk ◽

Surinporn Likhitsathian

Keyword(s):

Major Depressive Disorder ◽

Transcranial Magnetic Stimulation ◽

Adverse Events ◽

Depressive Disorder ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

First Episode ◽

Controlled Trials ◽

Large Sample Size ◽

Major Depressive

Objectives: The aims of this study were to systematically review the efficacy, acceptability, and tolerability of repetitive transcranial magnetic stimulation (rTMS) combined with antidepressants in the treatment of the first major depressive disorder (MDD) episode. Materials and Methods: The primary efficacious outcome was the pooled mean-endpoint scores of the Hamilton Depression Rating Scale (HAMD). Rates of response, remission rate, overall discontinuation and discontinuation due to adverse events were also evaluated. Search in the Scopus, PubMed, CINAHL, and Cochrane Controlled Trials Register databases for interesting outcomes was carried out in March 2018. Results: A total of 108 randomized patients of two randomized controlled trials were included in this study. The pooled mean- endpoint scores of the HAMD in one, two, and four weeks for rTMS plus antidepressants (citalopram or paroxetine) were greater than that of sham plus the antidepressants. The pooled rates of overall discontinuation and discontinuation rates due to adverse events were not different between the two groups. Conclusion: According to a piece of limited evidence, the high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) could accelerate the antidepressant effect of SSRIs in young patients with a first-episode major depressive disorder. However, the acceptability and tolerability of HF-rTMS in the treatment of such patients are no better than an antidepressant alone. However, further well-defined and large sample-size studies of HF-rTMS combined with an antidepressant in MDD should be carried out to warrant these results.

Download Full-text

EFFICACY AND SAFETY OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION USING AN H1-COIL OR FIGURE-8-COIL IN THE TREATMENT OF UNIPOLAR MAJOR DEPRESSIVE DISORDER: A STUDY PROTOCOL FOR A RANDOMIZED CONTROLLED TRIAL

Psychiatria Danubina ◽

10.24869/psyd.2018.41 ◽

2018 ◽

Vol 30 (1) ◽

pp. 41-46 ◽

Cited By ~ 2

Author(s):

Igor Filipcic ◽

◽

Ivona Simunovic Filipcic ◽

Tomislav Gajsak ◽

Zeljko Milovac ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Major Depressive Disorder ◽

Transcranial Magnetic Stimulation ◽

Depressive Disorder ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Efficacy And Safety ◽

Major Depressive ◽

Randomized Controlled

Download Full-text

Quantitative review of the efficacy of slow-frequency magnetic brain stimulation in major depressive disorder

Psychological Medicine ◽

10.1017/s003329171000005x ◽

2010 ◽

Vol 40 (11) ◽

pp. 1789-1795 ◽

Cited By ~ 79

Author(s):

D. J. L. G. Schutter

Keyword(s):

Major Depressive Disorder ◽

Transcranial Magnetic Stimulation ◽

Depressive Disorder ◽

Frontal Cortex ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Meta Analysis ◽

Major Depressive ◽

Double Blind ◽

Slow Frequency

BackgroundSlow-frequency repetitive transcranial magnetic stimulation (rTMS) to the frontal cortex has been suggested as a safer and better tolerable alternative to fast-frequency rTMS in the treatment of major depressive disorder (MDD). The aim of the present study was to examine the efficacy of slow-frequency rTMS to the frontal cortex in MDD.MethodA literature search was carried out in the databases PubMed and Web of Science in the period between January 1994 and July 2009 with the search terms ‘depression’ and ‘transcranial magnetic stimulation’. Nine double-blind sham-controlled parallel intention-to-treat studies (252 patients) fulfilled inclusion criteria and were entered in a random-effects meta-analysis.ResultsThe test for heterogeneity was not significant (QT=9.63,p=0.38). An overall weighted moderate mean effect size (d=0.63, 95% confidence interval=0.03–1.24) for active treatment was observed.ConclusionsThe findings suggest that slow-frequency rTMS to the frontal cortex is more effective than sham treatment and may be equally effective as fast-frequency rTMS in the treatment of MDD.

Download Full-text

Treatment for Major Depressive Disorder by Repetitive Transcranial Magnetic Stimulation in Different Parameters: A Randomized Double-Blinded Controlled Trial

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.623765 ◽

2021 ◽

Vol 12 ◽

Author(s):

Tingting Zhang ◽

Yueqin Huang ◽

Yi Jin ◽

Xiaoyan Ma ◽

Zhaorui Liu

Keyword(s):

Major Depressive Disorder ◽

Transcranial Magnetic Stimulation ◽

Depressive Disorder ◽

Magnetic Stimulation ◽

Rating Scale ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Repeated Measure ◽

Major Depressive ◽

Treatment Groups

Background: Repetitive transcranial magnetic stimulation (rTMS) has been proven to be safe and effective in treating major depressive disorder (MDD). However, the treatment parameters of rTMS are still divergent and need to be optimized further. The aim of this study was to compare the efficacy of rTMS in treating MDD with different parameters of stimulating frequency and location, and course of treatment.Methods: A total of 221 patients with MDD were recruited in the randomized, double-blind, controlled trial. All eligible patients were randomly assigned into four treatment groups: (1) 10 Hz in left dorsolateral pre-frontal cortex (DLPFC) (n = 55), (2) 5 Hz in left DLPFC (n = 53), (3) 10 Hz in bilateral DLPFC (n = 57), and (4) 5 Hz in bilateral DLPFC (n = 56). The patients received treatment for 6 weeks and an additional 6-week optional treatment. The efficacies were evaluated by Hamilton Depression Rating Scale-24 items (HDRS) and Clinical Global Impressions Scale (CGI). The trial is registered at the Chinese Clinical Trial Registry as ChiCTR-TRC-12002248.Results: The ANOVAs of HDRS scores up to 6 weeks and 12 weeks with repeated measure of time showed a significant effect of duration without statistical difference among four treatment groups and no significance when time was interacted with inter-group as well. The response rates up until the 5th week were significantly different with the previous week.Conclusions: It concludes that there were no statistical differences in the efficacy of rTMS between unilateral left and bilateral DLPFC, and between 5 and 10 Hz for treating MDD.

Download Full-text