Cost Analysis of Intermittent Theta Burst Stimulation (iTBS) Versus 10Hz Repetitive Transcranial Magnetic Stimulation (rTMS) in Patients with Treatment Resistant Depression

2019 ◽  
Author(s):  
Andrew B. Mendlowitz ◽  
Alaa Shanbour ◽  
Jonathan Downar ◽  
Fidel Vila-Rodriguez ◽  
Zafiris J. Daskalakis ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Cost Analysis ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Resistant Depression ◽  
Theta Burst Stimulation ◽  
Treatment Resistant ◽  
Burst Stimulation ◽  
Resistant Depression ◽  
Theta Burst

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.

scholarly journals Long-Term Efficacy of Combination Therapy of Transcranial Magnetic Stimulation with Ketamine for Patients with Treatment-Resistant Depression

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 171-171
Author(s):  
Steve Best ◽  
Dan G. Pavel ◽  
Natalie Haustrup
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Nmda Receptor Antagonist ◽  
Primary Diagnosis ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Invasive Treatment ◽  
Novel Approach ◽  
Resistant Depression

AbstractBackgroundRepetitive transcranial magnetic stimulation (rTMS) is a safe, effective and non-invasive treatment for many psychiatric illnesses, including treatment-resistant depression (TRD). Ketamine, an NMDA receptor antagonist, is also an effective antidepressant. This retrospective review examined the clinical benefits of combining these two established treatments for patients suffering from TRD in a novel approach coined combination TMS with ketamine (CTK).MethodsA group of 28 adult patients with a primary diagnosis of unipolar (n=18) or bipolar (n=10) depression received three CTK treatments a week at a private neuropsychiatric practice. Patients were given a concurrent treatment of rTMS (1Hz; 40 minutes; 130% of motor threshold) with bio-marker-determined IV ketamine infusions (0.2–4.7 mg/kg; 30 minutes). The TMS coil was positioned on the mid-prefrontal area. Frequency of treatment was dependent on patient responsiveness (10–30 sessions), which was measured as symptom reduction on the Clinical Global Impression (CGI) scale. CGI data was evaluated pre-treatment, post-treatment and at two-year follow-up.ResultsMean reduction in CGI severity for the patient group following CTK was 4.46 ± 0.54 at a 99% confidence interval and was deemed statistically significant using a paired t-test (a=0.01, t=22.81, p < 0.0001). This significant reduction in CGI severity was sustained for at least 2 years following treatment completion.ConclusionsDespite years of unsuccessful treatments, all 28 patients in this trial obtained substantial and enduring reductions in their depressive symptoms following CTK therapy. Further research into method optimization and randomized controlled trials are warranted.

The Effect of Repetitive Transcranial Magnetic Stimulation on Suicidal Ideation in Treatment-Resistant Depression

2022 ◽  
Vol 83 (2) ◽  
Author(s):  
Shobha Mehta ◽  
Gerasimos Konstantinou ◽  
Cory R. Weissman ◽  
Zafiris J. Daskalakis ◽  
Daphne Voineskos ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Suicidal Ideation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression
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