BACKGROUND:Transcranial magnetic stimulation (TMS) enables non-surgical activation of specific brain areas. TMS over the prefrontal cortex (PFC) is emerging as a significant tool that can augment or replace non/partially effective antidepressant medications. Deep TMS (DTMS) utilizes newly developed coils that enable effective stimulation of deeper cortical layers involved in the pathophysiology of depression. OBJECTIVES: We aimed to assess the H1-DTMS coil as an add-on to antidepressants in treating patients with major depression. We also intended to evaluate whether the antidepressant outcome of DTMS treatment is affected by a cognitive-emotional procedure performed during stimulation. METHODS:57 patients were enrolled in the study that included 4 weeks of daily 20 Hz stimulation sessions and additional 4 weekly sessions as a short maintenance phase. Two subgroups of patients received either positive or negative cognitive-emotional reactivation along with the stimulation sessions. RESULTS: 21 of 46 patients (46%) who received at least 10 stimulation sessions achieved response (improvement of ≥ 50% in the Hamilton Depression Rating Scale (HDRS)) and 13 of them (28%) achieved remission (HDRS-24 ≤ 10) by the end of the daily treatment phase. Improvements were smaller in the negatively reactivated group and Beck Depression Inventory scores were not significantly improved in this group. CONCLUSIONS:DTMS over the PFC proved to be safe and effective in augmenting antidepressant medications. Negative cognitive-emotional reactivation can disrupt the therapeutic effect of DTMS. A large sham controlled study is required to further establish the effectiveness of DTMS as an augmentation treatment and the role of cognitive reactivation during stimulation.
RCT Entities:
BACKGROUND: Transcranial magnetic stimulation (TMS) enables non-surgical activation of specific brain areas. TMS over the prefrontal cortex (PFC) is emerging as a significant tool that can augment or replace non/partially effective antidepressant medications. Deep TMS (DTMS) utilizes newly developed coils that enable effective stimulation of deeper cortical layers involved in the pathophysiology of depression. OBJECTIVES: We aimed to assess the H1-DTMS coil as an add-on to antidepressants in treating patients with major depression. We also intended to evaluate whether the antidepressant outcome of DTMS treatment is affected by a cognitive-emotional procedure performed during stimulation. METHODS: 57 patients were enrolled in the study that included 4 weeks of daily 20 Hz stimulation sessions and additional 4 weekly sessions as a short maintenance phase. Two subgroups of patients received either positive or negative cognitive-emotional reactivation along with the stimulation sessions. RESULTS: 21 of 46 patients (46%) who received at least 10 stimulation sessions achieved response (improvement of ≥ 50% in the Hamilton Depression Rating Scale (HDRS)) and 13 of them (28%) achieved remission (HDRS-24 ≤ 10) by the end of the daily treatment phase. Improvements were smaller in the negatively reactivated group and Beck Depression Inventory scores were not significantly improved in this group. CONCLUSIONS:DTMS over the PFC proved to be safe and effective in augmenting antidepressant medications. Negative cognitive-emotional reactivation can disrupt the therapeutic effect of DTMS. A large sham controlled study is required to further establish the effectiveness of DTMS as an augmentation treatment and the role of cognitive reactivation during stimulation.
Authors: Tyler S Kaster; Zafiris J Daskalakis; Yoshihiro Noda; Yuliya Knyahnytska; Jonathan Downar; Tarek K Rajji; Yechiel Levkovitz; Abraham Zangen; Meryl A Butters; Benoit H Mulsant; Daniel M Blumberger Journal: Neuropsychopharmacology Date: 2018-06-18 Impact factor: 7.853
Authors: Yechiel Levkovitz; Moshe Isserles; Frank Padberg; Sarah H Lisanby; Alexander Bystritsky; Guohua Xia; Aron Tendler; Zafiris J Daskalakis; Jaron L Winston; Pinhas Dannon; Hisham M Hafez; Irving M Reti; Oscar G Morales; Thomas E Schlaepfer; Eric Hollander; Joshua A Berman; Mustafa M Husain; Uzi Sofer; Ahava Stein; Shmulik Adler; Lisa Deutsch; Frederic Deutsch; Yiftach Roth; Mark S George; Abraham Zangen Journal: World Psychiatry Date: 2015-02 Impact factor: 49.548
Authors: Tarique Perera; Mark S George; Geoffrey Grammer; Philip G Janicak; Alvaro Pascual-Leone; Theodore S Wirecki Journal: Brain Stimul Date: 2016-03-16 Impact factor: 8.955
Authors: Chiara Rapinesi; Georgios D Kotzalidis; Daniele Serata; Antonio Del Casale; Francesco S Bersani; Andrea Solfanelli; Paola Scatena; Ruggero N Raccah; Roberto Brugnoli; Vittorio Digiacomantonio; Paolo Carbonetti; Claudio Fensore; Roberto Tatarelli; Gloria Angeletti; Stefano Ferracuti; Paolo Girardi Journal: Prim Care Companion CNS Disord Date: 2012-02-07