Preliminary communicationHigh frequency repetitive transcranial magnetic stimulation as an augmenting strategy in severe treatment-resistant major depression: A prospective 4-week naturalistic trial
Section snippets
Depressed patients
The present study was approved by the Douglas Mental Health University Institute's (DMHUI) Research Ethics Board, and written informed consent was obtained from all participants. A total convenience sample of 15 depressed subjects (7 males and 8 females) were recruited between September 2008 and 2009 from the Depressive Disorders Program at the DMHIU — a tertiary care outpatient clinic providing specialized follow-up for individuals with moderate to severe MDD. All participants had a primary
Sample characteristics
Demographic and baseline clinical information are presented in Table 1, while subjects' current pharmacological treatments are described in Table 2.
Subjects' ages ranged from 33 to 61 years, with a mean age of 47 years (SD = 8.51). They had a mean of 3.53 (SD = 1.246) failed antidepressants and a mean of 2.27 (SD = 1.335) failed augmenting agents (e.g., lithium and atypical antipsychotics) in the current MDE. Mean baseline HAM-D21, IDS-SR30, HAM-A, BAI, and CGI-S scores were 29.87 (SD = 7.1), 47.93 (SD =
Discussion
This prospective naturalistic study was designed to assess the effectiveness of HF rTMS as an augmenting strategy in a sample of subjects with severe TRD. Moreover, we sought to broaden our investigation to include variables beyond symptomatology, notably QOL.
As predicted, patients who were severely and chronically depressed with high levels of treatment resistance and psychiatric comorbidities presented with a clinically meaningful improvement in all measures of depression and anxiety.
Conclusions
The present study provides preliminary evidence that 4 weeks of daily HF rTMS over the left DLPFC is associated with clinically meaningful improvements in anxious and depressive symptoms, as well as in QOL in subjects with severe TRD. However, further randomized, controlled and double-blind trials should be carried out to better evaluate the usefulness of rTMS as an augmentation strategy in severe TRD.
Role of the funding source
We had no outside funding for this study.
Conflict of interest
The authors have no financial relationships or conflicts of interest to disclose.
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2016, Journal of Anxiety DisordersCitation Excerpt :During an emotional conflict task requiring implicit emotion regulation, patients with GAD also fail to engage the anterior cingulate cortex – a brain region associated with successful conflict resolution and emotion inhibition – relative to HC volunteers (Etkin, Prater, Hoeft, Menon, & Schatzberg, 2010). Neuromodulation using repetitive transcranial magnetic stimulaton (rTMS) is superior to sham in the treatment of depression (Berlim, Van den Eynde, & Jeff Daskalakis, 2013; Kedzior, Azorina, & Reitz, 2014), and evidence suggests that anxiety symptoms may also improve in depressed patients receiving neuromodulation therapies (Berlim, McGirr, Beaulieu, & Turecki, 2011; Diefenbach, Bragdon, & Goethe, 2013; Kedzior, Gellersen, Roth, & Zangen, 2015). Uncontrolled research has indicated that neuromodulation of the DLPFC improves anxiety symptoms in patients with GAD (Bystritsky et al., 2008; Shiozawa et al., 2014) and we have recently reported that in a randomized controlled trial (RCT) active DLPFC neuromodulation was superior to sham for improving GAD symptoms (Diefenbach et al., in press).
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2015, Pharmacology Biochemistry and BehaviorCitation Excerpt :A systematic review revealed that rTMS is an effective antidepressant treatment for adolescents with resistant depression (Donaldson et al., 2014). Although studies have found that the effectiveness of rTMS for some patients with depression is not obvious (Couturier, 2005), several randomized, controlled trials have reported that rTMS is effective in the treatment of depression or treatment-resistant depression (Berlim et al., 2011; Gaynes et al., 2014). Animal research has revealed that chronic rTMS increases hippocampal neurogenesis in rats (Ueyama et al., 2011), and the exposure of C57BL/6 mice to low-frequency electromagnetic fields results in improvements in hippocampus neurogenesis (Cuccurazzu et al., 2010).