BACKGROUND: A few studies have examined the durability of transcranial magnetic stimulation (TMS) antidepressant benefit once patients remitted. This study examined the long-term durability of clinical benefit from TMS using a protocol-specified TMS taper and either continuation pharmacotherapy or naturalistic follow-up. METHODS: Patients were remitters from an acute double-blind sham-controlled trial of TMS (n = 18), or from an open-label extension in patients who did not respond to the acute trial (n = 43). Long-term durability of TMS acute effect was examined in remitters over a 12-week follow-up. Relapse, defined as 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20, was the primary outcome. RESULTS:Of 61 remitters in the acute trial, five entered naturalistic follow-up and 50 entered the TMS taper. Thirty-two patients completed TMS taper and 1-, 2-, and 3-month follow-up. At 3-month visit, 29 of 50 (58%) were classified as in remission (HDRS-24 ≤10), two of 50 (4%) as partial responders (30%≤ HDRS-24 reduction <50% from baseline), and one of 50 (2%) met criteria for relapse. During the entire 3-month follow-up, five of the 37 patients relapsed (relapse rate = 13.5%), but four of them regained remission by the end of the study. The average time to relapse in these five patients was 7.2 ± 3.3 weeks. Patients who relapsed had higher depression scores at 1 month. CONCLUSIONS: While one third of the sample was lost to follow-up, our results demonstrate that most patients contributing to observations experienced persistence of benefit from TMS followed by pharmacotherapy or no medication. Longer follow-up and more rigorous studies are needed to explore the true long-term durability of remission produced by TMS.
RCT Entities:
BACKGROUND: A few studies have examined the durability of transcranial magnetic stimulation (TMS) antidepressant benefit once patients remitted. This study examined the long-term durability of clinical benefit from TMS using a protocol-specified TMS taper and either continuation pharmacotherapy or naturalistic follow-up. METHODS:Patients were remitters from an acute double-blind sham-controlled trial of TMS (n = 18), or from an open-label extension in patients who did not respond to the acute trial (n = 43). Long-term durability of TMS acute effect was examined in remitters over a 12-week follow-up. Relapse, defined as 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20, was the primary outcome. RESULTS: Of 61 remitters in the acute trial, five entered naturalistic follow-up and 50 entered the TMS taper. Thirty-two patients completed TMS taper and 1-, 2-, and 3-month follow-up. At 3-month visit, 29 of 50 (58%) were classified as in remission (HDRS-24 ≤10), two of 50 (4%) as partial responders (30%≤ HDRS-24 reduction <50% from baseline), and one of 50 (2%) met criteria for relapse. During the entire 3-month follow-up, five of the 37 patients relapsed (relapse rate = 13.5%), but four of them regained remission by the end of the study. The average time to relapse in these five patients was 7.2 ± 3.3 weeks. Patients who relapsed had higher depression scores at 1 month. CONCLUSIONS: While one third of the sample was lost to follow-up, our results demonstrate that most patients contributing to observations experienced persistence of benefit from TMS followed by pharmacotherapy or no medication. Longer follow-up and more rigorous studies are needed to explore the true long-term durability of remission produced by TMS.
Authors: Mark S George; Sarah H Lisanby; David Avery; William M McDonald; Valerie Durkalski; Martina Pavlicova; Berry Anderson; Ziad Nahas; Peter Bulow; Paul Zarkowski; Paul E Holtzheimer; Theresa Schwartz; Harold A Sackeim Journal: Arch Gen Psychiatry Date: 2010-05
Authors: John P O'Reardon; H Brent Solvason; Philip G Janicak; Shirlene Sampson; Keith E Isenberg; Ziad Nahas; William M McDonald; David Avery; Paul B Fitzgerald; Colleen Loo; Mark A Demitrack; Mark S George; Harold A Sackeim Journal: Biol Psychiatry Date: 2007-06-14 Impact factor: 13.382
Authors: Sarah H Lisanby; Mustafa M Husain; Peter B Rosenquist; Daniel Maixner; Rosben Gutierrez; Andrew Krystal; William Gilmer; Lauren B Marangell; Scott Aaronson; Zafiris J Daskalakis; Randolph Canterbury; Elliott Richelson; Harold A Sackeim; Mark S George Journal: Neuropsychopharmacology Date: 2008-08-13 Impact factor: 7.853
Authors: Asli Demirtas-Tatlidede; Dawn Mechanic-Hamilton; Daniel Z Press; Chester Pearlman; William M Stern; Mark Thall; Alvaro Pascual-Leone Journal: J Clin Psychiatry Date: 2008-06 Impact factor: 4.384
Authors: Xingbao Li; Leah Fryml; Julia Jaskwich Rodriguez; Joseph Taylor; Jeff J Borckardt; Baron Short; Greg Sahlem; Donna Roberts; Mark S George Journal: Brain Stimul Date: 2014-10-07 Impact factor: 8.955
Authors: Shawn M McClintock; Irving M Reti; Linda L Carpenter; William M McDonald; Marc Dubin; Stephan F Taylor; Ian A Cook; John O'Reardon; Mustafa M Husain; Christopher Wall; Andrew D Krystal; Shirlene M Sampson; Oscar Morales; Brent G Nelson; Vassilios Latoussakis; Mark S George; Sarah H Lisanby Journal: J Clin Psychiatry Date: 2018 Jan/Feb Impact factor: 4.384
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