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Aşık M, İlhan R, Günver MG, Orhan Ö, Esmeray MT, Kalaba Ö, Arıkan MK. Multimodal Neuroimaging in the Prediction of Deep TMS Response in OCD. Clin EEG Neurosci 2025; 56:207-216. [PMID: 39563493 DOI: 10.1177/15500594241298977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2024]
Abstract
Backgrounds: Brain morphological biomarkers could contribute to understanding the treatment response in patients with obsessive-compulsive disorder (OCD). Multimodal neuroimaging addresses this issue by providing more comprehensive information regarding neural processes and structures. Objectives. The present study aims to investigate whether patients responsive to deep Transcranial Magnetic Stimulation (TMS) differ from non-responsive individuals in terms of electrophysiology and brain morphology. Secondly, to test whether multimodal neuroimaging is superior to unimodal neuroimaging in predicting response to deep TMS. Methods. Thirty-two OCD patients who underwent thirty sessions of deep TMS treatment were included in the study. Based on a minimum 50% reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores after treatment, patients were grouped as responders (n = 25) and non-responders (n = 7). The baseline resting state qEEG and magnetic resonance imaging (MRI) records of patients were recorded. Independent sample t-test is used to compare the groups. Then, three logistic regression model were calculated for only QEEG markers, only MRI markers, and both QEEG/MRI markers. The predictive values of the three models were compared. Results. OCD patients who responded to deep TMS treatment had increased Alpha-2 power in the left temporal area and increased volume in the left temporal pole, entorhinal area, and parahippocampal gyrus compared to non-responders. The logistic regression model showed better prediction performance when both QEEG and MRI markers were included. Conclusions. This study addresses the gap in the literature regarding new functional and structural neuroimaging markers and highlights the superiority of multimodal neuroimaging to unimodal neuroimaging techniques in predicting treatment response.
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Affiliation(s)
- Murat Aşık
- Istanbul Medeniyet University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Reyhan İlhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | - Mehmet Güven Günver
- Faculty of Medicine, Department of Biostatistics, Istanbul University, Istanbul, Turkey
| | - Özden Orhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | | | - Öznur Kalaba
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
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Hsu TW, Yeh TC, Kao YC, Thompson T, Brunoni AR, Carvalho AF, Hsu CW, Tu YK, Liang CS. The dose-effect relationship of six stimulation parameters with rTMS over left DLPFC on treatment-resistant depression: A systematic review and meta-analysis. Neurosci Biobehav Rev 2024; 162:105704. [PMID: 38723735 DOI: 10.1016/j.neubiorev.2024.105704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 05/20/2024]
Abstract
This study aimed to evaluate the association of the six parameters, namely stimulation intensity, stimulation frequency, pulses per session, treatment duration, number of sessions, and total number of pulses with the efficacy of conventional transcranial magnetic stimulation (rTMS) over left dorsolateral prefrontal cortex for patients with treatment-resistant depression (TRD). A random-effects dose-response meta-analysis of blinded randomized controlled trials (RCTs) involving 2391 participants were conducted to examine the dose-effect relationship of six stimulation parameters. Any of the six parameters significantly individually predicted proportion of variance in efficacy: pulses per session (R²=52.7%), treatment duration (R²=51.2%), total sessions (R²=50.9%), frequency (R²=49.6%), total pulses (R²=49.5%), and intensity (R²= 40.4%). Besides, we identified frequency as a potential parameter interacting with the other five parameters, resulting in a significant increase in variance(ΔR2) ranging from 5.0% to 16.7%. Finally, we found that RCTs using frequency > 10 Hz compared to those of 10 Hz showed better dose-effect relationships. We conclude that the six stimulation parameters significantly predict the dose-effect relationship of conventional rTMS on TRD. Besides, higher stimulation frequency, higher stimulation intensity, and adequate number of pulses were associated with treatment efficacy.
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Affiliation(s)
- Tien-Wei Hsu
- Department of Psychiatry, E-DA Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Psychaitry, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil; Service of Electroconvulsive Therapy, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Kang Tu
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan; Institute of Health Data Analytics & Statistics, College of Public Health, National Taiwan University, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan.
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Dong MS, Rokicki J, Dwyer D, Papiol S, Streit F, Rietschel M, Wobrock T, Müller-Myhsok B, Falkai P, Westlye LT, Andreassen OA, Palaniyappan L, Schneider-Axmann T, Hasan A, Schwarz E, Koutsouleris N. Multimodal workflows optimally predict response to repetitive transcranial magnetic stimulation in patients with schizophrenia: a multisite machine learning analysis. Transl Psychiatry 2024; 14:196. [PMID: 38664377 PMCID: PMC11045783 DOI: 10.1038/s41398-024-02903-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
The response variability to repetitive transcranial magnetic stimulation (rTMS) challenges the effective use of this treatment option in patients with schizophrenia. This variability may be deciphered by leveraging predictive information in structural MRI, clinical, sociodemographic, and genetic data using artificial intelligence. We developed and cross-validated rTMS response prediction models in patients with schizophrenia drawn from the multisite RESIS trial. The models incorporated pre-treatment sMRI, clinical, sociodemographic, and polygenic risk score (PRS) data. Patients were randomly assigned to receive active (N = 45) or sham (N = 47) rTMS treatment. The prediction target was individual response, defined as ≥20% reduction in pre-treatment negative symptom sum scores of the Positive and Negative Syndrome Scale. Our multimodal sequential prediction workflow achieved a balanced accuracy (BAC) of 94% (non-responders: 92%, responders: 95%) in the active-treated group and 50% in the sham-treated group. The clinical, clinical + PRS, and sMRI-based classifiers yielded BACs of 65%, 76%, and 80%, respectively. Apparent sadness, inability to feel, educational attainment PRS, and unemployment were most predictive of non-response in the clinical + PRS model, while grey matter density reductions in the default mode, limbic networks, and the cerebellum were most predictive in the sMRI model. Our sequential modelling approach provided superior predictive performance while minimising the diagnostic burden in the clinical setting. Predictive patterns suggest that rTMS responders may have higher levels of brain grey matter in the default mode and salience networks which increases their likelihood of profiting from plasticity-inducing brain stimulation methods, such as rTMS. The future clinical implementation of our models requires findings to be replicated at the international scale using stratified clinical trial designs.
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Grants
- FA-210/1 Deutsche Forschungsgemeinschaft (German Research Foundation)
- SCHW 1768/1-1 Deutsche Forschungsgemeinschaft (German Research Foundation)
- FA-210/1 Deutsche Forschungsgemeinschaft (German Research Foundation)
- SCHW 1768/1-1 Deutsche Forschungsgemeinschaft (German Research Foundation)
- FA-210/1 Deutsche Forschungsgemeinschaft (German Research Foundation)
- SCHW 1768/1-1 Deutsche Forschungsgemeinschaft (German Research Foundation)
- FA-210/1 Deutsche Forschungsgemeinschaft (German Research Foundation)
- 01ZX1904A Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie (Federal Ministry for Education, Science, Research and Technology)
- 01KU1905A Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie (Federal Ministry for Education, Science, Research and Technology)
- 01ZX1904A Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie (Federal Ministry for Education, Science, Research and Technology)
- 01KU1905A Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie (Federal Ministry for Education, Science, Research and Technology)
- 01ZX1904A Bundesministerium für Bildung, Wissenschaft und Kultur (Federal Ministry of Education, Science and Culture)
- ENP-161423 Gouvernement du Canada | Canadian Institutes of Health Research (Instituts de Recherche en Santé du Canada)
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Affiliation(s)
- Mark Sen Dong
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Jaroslav Rokicki
- Centre of Research and Education in Forensic Psychiatry, Oslo Univerisity Hospital, Oslo, Norway
| | - Dominic Dwyer
- The University of Melbourne, Melbourne, VIC, Australia
| | - Sergi Papiol
- Max Planck Institute of Psychiatry, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Fabian Streit
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marcella Rietschel
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Wobrock
- Centre for Mental Health, Darmstadt-Dieburg District Clinic, Gross-Umstadt, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
- Max Planck Institute of Psychiatry, Munich, Germany
- Partner site Munich-Augsburg, DZPG (German Centre for Mental Health), Munich / Augsburg, Germany
| | | | - Ole A Andreassen
- Centre for Precision Psychiatry, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
- Robarts Research Institute, Western University, London Ontario, Canada
| | - Thomas Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Alkomiet Hasan
- Partner site Munich-Augsburg, DZPG (German Centre for Mental Health), Munich / Augsburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Emanuel Schwarz
- Department for Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University of Munich, Munich, Germany.
- Max Planck Institute of Psychiatry, Munich, Germany.
- Partner site Munich-Augsburg, DZPG (German Centre for Mental Health), Munich / Augsburg, Germany.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Göke K, Trevizol AP, Ma C, Mah L, Rajji TK, Daskalakis ZJ, Downar J, McClintock SM, Nestor SM, Noda Y, Mulsant BH, Blumberger DM. Predictors of remission after repetitive transcranial magnetic stimulation for the treatment of late-life depression. Psychiatry Res 2024; 334:115822. [PMID: 38452496 DOI: 10.1016/j.psychres.2024.115822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment in patients with depression, yet treatment response remains variable. While previous work has identified predictors of remission in younger adults, relatively little data exists in late-life depression (LLD). To address this gap, data from 164 participants with LLD from a randomized non-inferiority treatment trial comparing standard bilateral rTMS to bilateral theta burst stimulation (TBS) (ClinicalTrials.gov identifier: NCT02998580) were analyzed using binary logistic regression and conditional inference tree (CIT) modeling. Lower baseline depression symptom severity, fewer prior antidepressant treatment failures, and higher global cognition predicted remission following rTMS treatment. The CIT predicted a higher likelihood of achieving remission for patients with a total score of 19 or lower on the Montgomery-Åsberg Depression Rating Scale, 1 or fewer prior antidepressant treatment failures, and a total score of 23 or higher on the Montreal Cognitive Assessment. Our results indicate that older adults with lower severity of depression, fewer antidepressant treatment failures, and higher global cognition benefit more from current forms of rTMS. The results suggest that there is potentially higher value in using rTMS earlier in the treatment pathway for depression in older adults.
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Affiliation(s)
- Katharina Göke
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Alisson P Trevizol
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Clement Ma
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Linda Mah
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Zafiris J Daskalakis
- Department of Psychiatry, University of California, San Diego Health, California, USA
| | - Jonathan Downar
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shawn M McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sean M Nestor
- Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Faculty of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Benoit H Mulsant
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel M Blumberger
- Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Tao Y, Liang Q, Zhang F, Guo S, Fan L, Zhao F. Efficacy of non-invasive brain stimulation combined with antidepressant medications for depression: a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2024; 13:92. [PMID: 38509623 PMCID: PMC10953221 DOI: 10.1186/s13643-024-02480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Antidepressants, noninvasive brain stimulation (NIBS), and their combination are commonly used in routine clinical practice. Nevertheless, there is a continuous dispute regarding whether the effectiveness of NIBS in combination with antidepressants exceeds that of antidepressants alone. This meta-analysis aimed to evaluate the existing evidence and draw a definitive conclusion on this issue. METHODS We conducted a comprehensive search of five databases: Embase, PubMed, Web of Science, SinoMed, and the Cochrane Database of Randomized Controlled Trials. The search was conducted until October 6, 2023. The primary outcomes were the pre- and post-intervention depression and anxiety scores. Secondary outcomes included dropout rates, response rates, and certain levels of neurotransmitters [ 5-hydroxytryptamine (5-HT), dopamine (DA), and gamma-aminobutyric acid (GABA)] at the end of the intervention. Subgroup, meta-regression, and sensitivity analyses were performed to explore the sources of heterogeneity. The data were analysed using R 4.2.2. RESULTS We included 18 RCTs [1357 participants; 11 studies used repetitive transcranial magnetic stimulation (rTMS) and 7 studies used transcranial direct current stimulation (tDCS)]. The follow-up duration varied from two weeks to three months. Overall, whether in combination with rTMS or tDCS, antidepressants proved more effective in alleviating depressive symptoms compared to when used as monotherapy. However, this advantage was not evident during the follow-up period. (p > 0.05). And the combination's efficacy in improving anxiety was found to be lacking. Post-treatment serum levels of 5-HT, DA, and GABA were higher in the rTMS group were higher than antidepressant medication group (p < 0.05). Furthermore, subgroup analysis results indicated that only the rTMS + antidepressant medication treatment significantly improved remission and remission rates. The meta-regression results showed that the type of antidepressant and the sex of the participants had a significant association with the depression score. CONCLUSION Combination treatment with NIBS was significantly more effective in improving depression symptoms than medication alone. rTMS combined with antidepressants appears to be more effective in improving response and remission rates. However, efficacy may be influenced by the type of medicine used in combination, and long-term efficacy data is lacking. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023388259.
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Affiliation(s)
- Yuan Tao
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 73000, PR China
| | - Qian Liang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 73000, PR China
| | - Fenghong Zhang
- Second Provincial Peoples Hospital of Gansu, Lanzhou, 73000, PR China
| | - Shaofan Guo
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, 73000, PR China
| | - Lingyun Fan
- Second Provincial Peoples Hospital of Gansu, Lanzhou, 73000, PR China
| | - Fei Zhao
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, 730030, PR China.
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Massé-Leblanc C, Desbeaumes Jodoin V, Nguyen DK, Fournier-Gosselin MP, Stip E, Lespérance P, Miron JP. Evaluating real-world effectiveness of accelerated transcranial magnetic stimulation for treatment-resistant depression in a tertiary referral center based in Quebec, Canada. Psychiatry Res 2024; 332:115685. [PMID: 38154411 DOI: 10.1016/j.psychres.2023.115685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To assess the effectiveness of accelerated transcranial magnetic stimulation (TMS) for treatment-resistant depression (TRD) in a tertiary referral center in Quebec, Canada, focusing on a real-world clinical setting. METHODS We reviewed the data of 247 TRD patients treated between January 2012 and May 2022 who received accelerated TMS. Participants were adults diagnosed with unipolar or bipolar depression, resistant to at least two antidepressant trials, and assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS Significant symptom reduction was found in the completer sample (N = 147), with 46.3 % of patients meeting post-treatment response criteria and 36.1 % achieving remission. Baseline severity of depression, age, and the number of antidepressant trials were key predictors of treatment outcomes. Patients who did not complete treatment had generally more severe depressive and anxious symptoms and greater treatment resistance. No significant differences in response rates were observed across different TMS coils. CONCLUSION The study demonstrated the effectiveness and tolerability of accelerated TMS for TRD in a real-world clinical setting.
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Affiliation(s)
- Camille Massé-Leblanc
- Département de Neurosciences, Faculté of Médecine, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Véronique Desbeaumes Jodoin
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Dang Khoa Nguyen
- Département de Neurosciences, Faculté of Médecine, Université de Montréal, Montréal, QC, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Fournier-Gosselin
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de chirurgie et de neurochirurgie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Emmanuel Stip
- Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Paul Lespérance
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Jean-Philippe Miron
- Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM), Université de Montréal, Montréal, QC, Canada; Département de Psychiatrie et d'Addictologie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
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Yu CL, Kao YC, Thompson T, Brunoni AR, Hsu CW, Carvalho AF, Chu CS, Tseng PT, Tu YK, Yang FC, Su KP, Cheng SL, Hsu TW, Liang CS. The association of total pulses with the efficacy of repetitive transcranial magnetic stimulation for treatment-resistant major depression: A dose-response meta-analysis. Asian J Psychiatr 2024; 92:103891. [PMID: 38183740 DOI: 10.1016/j.ajp.2023.103891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/26/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
AIM This study aimed to examine dose-effects of total pulses on improvement of depressive symptoms in patients with treatment-resistant depression (TRD) receiving repetitive transcranial magnetic stimulation (rTMS) over the left dorsal lateral prefrontal cortex (DLPFC). MATERIALS AND METHODS The MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PsycINFO, and ClinicalTrial.gov databases were systematically searched. We included randomized, double-blind, placebo-controlled trials (RCT) that used rTMS over left DLPFC in patients with TRD. Excluded studies were non-TRD, non-RCTs, or combined other brain stimulation interventions. The outcome of interest was the difference between rTMS arms and sham controls in improvement of depressive symptoms in a dose-response manner. A random-effects meta-analysis and dose-response meta-analysis(DRMA) was used to examine antidepressant efficacy of rTMS and association with total pulses. RESULTS We found that rTMS over left DLPFC is superior to sham controls (reported as standardized mean difference[SMD] with 95% confidence interval: 0.77; 0.56-0.98). The best-fitting model of DRMA was bell-shaped (estimated using restricted cubic spline model; R2 =0.42), indicating that higher doses (>26,660 total pulses) were not associated with increased improvement of depressive symptoms. Stimulation frequency(R2 =0.53) and age(R2 =0.51) were significant moderators for the dose-response curve. Furthermore, 15-20 Hz rTMS was superior to 10 Hz rTMS (0.61, 0.15-1.10) when combining all doses. CONCLUSIONS Our findings suggest higher doses(total pulses) of rTMS were not always associated with increased improvement of depressive symptoms in patients with TRD, and that the dose-response relationship was moderated by stimulation frequency and age. These associations emphasize the importance of determining dosing parameters to achieve maximum efficacy.
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Affiliation(s)
- Chia-Ling Yu
- Department of Pharmacy, Chang Gung Memorial Hospital Linkou, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation, National Institute of Biomarkers in Psychiatry, Laboratory of Neurosciences (LIM-27), Departamento de Instituto de Psiquiatria, Faculdade de Medicina da University of Sao Paulo, Sao Paulo, Brazil; Departamento de Ciências Médicas, Faculdade de Medicina da University of São Paulo, São Paulo, Brazil
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Che-Sheng Chu
- Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Non-invasive Neuromodulation Consortium for Mental Disorders, Society of Psychophysiology, Taipei, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ping-Tao Tseng
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan; Institute of Precision Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Fu-Chi Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan
| | - Kuan-Pin Su
- College of Medicine, China Medical University, Taichung, Taiwan; Mind-Body Interface Laboratory (MBI-Lab), China Medical University and Hospital, Taichung 404, Taiwan; An-Nan Hospital, China Medical University, Tainan 709, Taiwan
| | - Shu-Li Cheng
- Department of Nursing, Mackay Medical College, Taipei, Taiwan.
| | - Tien-Wei Hsu
- Department of Psychiatry, E-DA Dachang Hospital, I-Shou University, Kaohsiung, Taiwan; Department of Psychiatry, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.
| | - Chih-Sung Liang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Centre, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
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8
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Gajšak T, Milovac Ž, Gereš N, Sučić S, Zoričić Z, Filipčić I. The effect of deep repetitive transcranial magnetic stimulation with an H1 coil on hopelessness in patients with major depressive disorder: A randomized controlled trial. World J Biol Psychiatry 2024; 25:16-25. [PMID: 37727902 DOI: 10.1080/15622975.2023.2251055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVES To assess the efficacy of repetitive transcranial magnetic stimulation (rTMS) with an H1 coil as a treatment for hopelessness in patients with major depressive disorder (MDD). METHODS We conducted a randomised controlled trial in a tertiary psychiatric institution in Croatia, including patients diagnosed with MDD without psychotic symptoms and with clinically relevant hopelessness. High-frequency (18 Hz) rTMS with an H1 coil was administered over four weeks on the left dorsolateral prefrontal cortex. We examined changes in the Beck Hopelessness Scale (BHS) scores. RESULTS We randomly assigned 51 participants to the intervention group (rTMS plus standard therapy) and 52 to the control group (standard therapy). The mean (SD) ages were 50 (12.3) and 50 (10.4) years, and 47% and 52% of the participants were females in the intervention and control groups, respectively. Following treatment, the BHS scores decreased (unadjusted bivariate analysis, p = 0.043; false discovery rate (FDR) >5%). Multivariate analysis revealed that the BHS score was reduced by 10.8% (95% confidence interval (CI: -17.8% to -3.9%) in the rTMS group and 0.7% (95% CI: 7.5% -6.1%) in the control group (p = 0.037; FDR < 5%). CONCLUSIONS rTMS with an H1 coil improved the symptoms of hopelessness in patients with MDD.
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Affiliation(s)
| | | | - Natko Gereš
- Psychiatric Clinic 'Sveti Ivan', Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | | | - Zoran Zoričić
- Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, Croatia
| | - Igor Filipčić
- Psychiatric Clinic 'Sveti Ivan', Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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9
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Zelada MI, Garrido V, Liberona A, Jones N, Zúñiga K, Silva H, Nieto RR. Brain-Derived Neurotrophic Factor (BDNF) as a Predictor of Treatment Response in Major Depressive Disorder (MDD): A Systematic Review. Int J Mol Sci 2023; 24:14810. [PMID: 37834258 PMCID: PMC10572866 DOI: 10.3390/ijms241914810] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) has been studied as a biomarker of major depressive disorder (MDD). Besides diagnostic biomarkers, clinically useful biomarkers can inform response to treatment. We aimed to review all studies that sought to relate BDNF baseline levels, or BDNF polymorphisms, with response to treatment in MDD. In order to achieve this, we performed a systematic review of studies that explored the relation of BDNF with both pharmacological and non-pharmacological treatment. Finally, we reviewed the evidence that relates peripheral levels of BDNF and BDNF polymorphisms with the development and management of treatment-resistant depression.
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Affiliation(s)
- Mario Ignacio Zelada
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
| | - Verónica Garrido
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
| | - Andrés Liberona
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
| | - Natalia Jones
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
| | - Karen Zúñiga
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
| | - Hernán Silva
- Clínica Psiquiátrica Universitaria, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago 8380453, Chile
- Departamento de Psiquiatría y Salud Mental Norte, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
| | - Rodrigo R. Nieto
- Clínica Psiquiátrica Universitaria, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago 8380453, Chile
- Departamento de Psiquiatría y Salud Mental Norte, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
- Departamento de Neurociencias, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
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10
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Cao P, Li Y, An B, Ye L, Xu Z. Efficacy and safety of repetitive transcranial magnetic stimulation combined with antidepressants in children and adolescents with depression: A systematic review and meta-analysis. J Affect Disord 2023; 336:25-34. [PMID: 37211054 DOI: 10.1016/j.jad.2023.05.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/07/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Repetitive Transcranial magnetic stimulation (rTMS) combined with antidepressants benefited adults with depression while its efficacy and safety in children and adolescents with depression remain controversial. METHODS We searched PubMed, Embase, the Cochrane Library, Web of Science, CINAHL, LILACS, PsycINFO, CNKI, Wanfang Data Knowledge Service Platform, a Chinese Biology Medical disc database, and relevant clinical registration databases for randomized controlled trials from their inception to October 18, 2022. The efficacy of the treatment was assessed by changes in depression rating scale scores. Safety was assessed by the incidence of adverse events. Heterogeneity was determined using the Cochrane Q statistics and I2 statistics. Publication bias was assessed by Egger's test. RESULTS Eighteen studies from 10 datasets (1396 patients, 64.7 % female, age range from 8 to 24 years old). The pooled mean-endpoint scores of the depression scale for rTMS combined with the antidepressant group were significantly lower than those of sham combined with the antidepressant group both in two weeks (MD = -4.68, 95 % CI: [-6.66, -2.69]; I2 = 91 %; P < 0.05) and four weeks (MD = -5.53, 95 % CI: [-9.90, -1.16]; I2 = 98 %; P < 0.05). There were no differences in safety (OR = 0.64, 95 % CI: [0.20, 2.04]; I2 = 64 %; P = 0.45) and acceptability between the two groups (3/70 vs 3/70). LIMITATION Heterogeneity was found in this study due to the limited number of original studies included. CONCLUSION rTMS combined with antidepressants enhanced the efficacy of the antidepressant medication. The safety and acceptability of the two groups were comparable. These findings may help guide future research and clinical practice.
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Affiliation(s)
- Pengpeng Cao
- Department of Pathogenic Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, PR China
| | - Yuhao Li
- Department of Pathogenic Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, PR China
| | - Bei An
- Department of Pathogenic Biology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, PR China.
| | - Lanxian Ye
- Department of Psychiatry, Lanzhou University Second Hospital, Lanzhou, PR China
| | - Zheng Xu
- Evidence-Based Medicine Center, The Centre of Evidence-based Social Science, School of Basic Medicine, Lanzhou University, Lanzhou, PR China
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11
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Taylor H, Nicholas P, Hoy K, Bailey N, Tanglay O, Young IM, Dobbin L, Doyen S, Sughrue ME, Fitzgerald PB. Functional connectivity analysis of the depression connectome provides potential markers and targets for transcranial magnetic stimulation. J Affect Disord 2023; 329:539-547. [PMID: 36841298 DOI: 10.1016/j.jad.2023.02.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/02/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Despite efforts to improve targeting accuracy of the dorsolateral prefrontal cortex (DLPFC) as a repetitive transcranial magnetic stimulation (rTMS) target for Major Depressive Disorder (MDD), the heterogeneity in clinical response remains unexplained. OBJECTIVE We sought to compare the patterns of functional connectivity from the DLPFC treatment site in patients with MDD who were TMS responders to those who were TMS non-responders. METHODS Baseline anatomical T1 magnetic resonance imaging (MRI), resting-state functional MRI, and diffusion weighted imaging scans were obtained from 37 participants before they underwent a course of rTMS to left Brodmann area 46. A novel machine learning method was utilized to identify brain regions associated with each item of the Beck's Depression Inventory II (BDI-II), and for 26 participants who underwent rTMS treatment over the left Brodmann area 46, identify regions differentiating rTMS responders and non-responders. RESULTS Nine parcels of the Human Connectome Project Multimodal Parcellation Atlas matched to at least three items of the Beck's Depression Inventory II (BDI-II) as predictors of response to rTMS, with many in the temporal, parietal and cingulate cortices. Additionally, pre-treatment mapping for 17 items of the BDI-II demonstrated significant variability in symptom to parcel mapping. When parcels associated with symptom presence and symptom resolution were compared, 15 parcels were uniquely associated with resolution (potential targets), and 12 parcels were associated with both symptom presence and resolution (blockers or biomarkers). CONCLUSIONS Machine learning approaches show promise for the development of pathoanatomical diagnosis and treatment algorithms for MDD. Prospective studies are required to facilitate clinical translation.
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Affiliation(s)
- Hugh Taylor
- Omniscient Neurotechnology, Sydney, Australia
| | | | - Kate Hoy
- Central Clinical School Department of Psychiatry, Monash University, Camberwell, Victoria, Australia; Bionics Institute, 384-388 Albert St, East Melbourne, Vic 3002, Australia
| | - Neil Bailey
- Central Clinical School Department of Psychiatry, Monash University, Camberwell, Victoria, Australia; Monarch Research Institute Monarch Mental Health Group, Sydney, New South Wales, Australia; School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
| | | | | | | | | | | | - Paul B Fitzgerald
- School of Medicine and Psychology, The Australian National University, Canberra, ACT, Australia
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12
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Bouaziz N, Laidi C, Bulteau S, Berjamin C, Thomas F, Moulier V, Benadhira R, Szekely D, Poulet E, Galvao F, Guillin O, Castillo MC, Sauvaget A, Plaze M, Januel D, Brunelin J, Rotharmel M. Real world transcranial magnetic stimulation for major depression: A multisite, naturalistic, retrospective study. J Affect Disord 2023; 326:26-35. [PMID: 36708953 DOI: 10.1016/j.jad.2023.01.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND In 2008, the U.S. FDA approved rTMS as a treatment against medication-resistant depression. However, real-world rTMS outcomes remain understudied. This study investigates how rTMS for depression is delivered in routine clinical practice in France, and measures its effectiveness as well as its moderators. METHODS Five centers provided retrospective data on patients who were treated with rTMS for treatment-resistant depression from January 2015 to December 2020. Patients were assessed twice using a hetero-questionnaire, with baseline and immediate post-treatment assessments. We conducted univariate analyses to study which factors were significantly associated with rTMS effectiveness. We then included age, gender, and significant factors in a multivariate model. RESULTS We collected data from 435 patients with a mean age of 51.27 (14.91): 66 % were female, and 26 % suffered from bipolar depression. Stimulation was delivered using four different stimulation parameters: 1 Hz (7 % of the individuals), 10 Hz (43 %), 20 Hz (12 %), and 50 Hz (intermittent Theta Burst Stimulation, iTBS) (38 %). The mean improvement of depressive symptoms was 33 % (p < 0.001, effect-size: 0.79). Response and remission rates were of 31 % and 22.8 %, respectively. In the multivariate analysis, improvement in depressive symptoms was associated with higher baseline symptoms. CONCLUSION This is one of the largest studies that investigates, with careful clinician-rated scales by trained psychiatrists, the effect of rTMS in naturalistic settings. Repetitive TMS appears to be effective in routine clinical practice, although its efficacy could be improved by analyzing predictors of response, as well as personalized targeting of specific brain areas.
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Affiliation(s)
- Noomane Bouaziz
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; La Fondation FondaMental, F-94010 Créteil, France.
| | - Charles Laidi
- La Fondation FondaMental, F-94010 Créteil, France; Pôle de Psychiatrie, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine de Créteil, DMU IMPACT, Hôpitaux Universitaires Mondor, Créteil, France
| | - Samuel Bulteau
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - Caroline Berjamin
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - Fanny Thomas
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France
| | - Virginie Moulier
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | - René Benadhira
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France
| | | | - Emmanuel Poulet
- Psychiatric emergency service, Hospices Civils de Lyon, F-69005 Lyon, France; Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Filipe Galvao
- Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Olivier Guillin
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
| | | | - Anne Sauvaget
- CHU Nantes, Department of Addictology and Psychiatry, Nantes, France
| | - Marion Plaze
- GHU Paris Psychiatrie & Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Dominique Januel
- EPS Ville Evrard, Pôle 93G03, Centre de Recherche Clinique, Neuilly-sur-Marne, France.; La Fondation FondaMental, F-94010 Créteil, France; Université Sorbonne Paris Nord. France
| | - Jérôme Brunelin
- Psychiatric emergency service, Hospices Civils de Lyon, F-69005 Lyon, France; Centre Hospitalier Le Vinatier, PSYR2 team, CRNL, INSERM U1028, CNRS UMR5292, Université Lyon 1, F-69500 Bron cedex, France
| | - Maud Rotharmel
- University Department of Psychiatry, Centre d'Excellence Thérapeutique-Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
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Lacroix A, Paquet A, Okassa M, Vinais T, Lannaud M, Plansont B, Buisson A, Guignandon S, Malauzat D, Girard M, Calvet B. Distinct Predictors of Clinical Response after Repetitive Transcranial Magnetic Stimulation between Bipolar and Unipolar Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5276. [PMID: 37047892 PMCID: PMC10094223 DOI: 10.3390/ijerph20075276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) has been shown to be therapeutically effective for patients suffering from drug-resistant depression. The distinction between bipolar and unipolar disorders would be of great interests to better adapt their respective treatments. Methods: We aimed to identify the factors predicting clinical improvement at one month (M1) after the start of rTMS treatment for each diagnosis, which was preceded by a comparison of the patients' clinical conditions. We used the data collected and the method employed in a previous publication on 291 patients. Results: Although the bipolar group had fewer responders, these patients seemed to better maintain their post-rTMS improvement on anxiety and perception of the severity of their illness than those in the unipolar group. For the bipolar group, young age coupled with low number of medications and high fatigue was shown to be the best combination for predicting improvement at M1. The duration of current depressive episode, which was previously demonstrated for whole group, combined with being attached was shown to favor clinical improvement among the patients in unipolar group. Conclusion: We were able to define a combination of specific factors related to each diagnosis for predicting the patients' clinical response. This could be extremely useful to predict the efficacy of rTMS during routine clinical practice in neuromodulation services.
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Affiliation(s)
- Aurélie Lacroix
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
- INSERM, U1094 Institut d’Epidémiologie et de Neurologie Tropicale, Université de Limoges, CHU Limoges, IRD U270, GEIST, 87000 Limoges, France
| | - Aude Paquet
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
- INSERM, U1094 Institut d’Epidémiologie et de Neurologie Tropicale, Université de Limoges, CHU Limoges, IRD U270, GEIST, 87000 Limoges, France
- Centre de Recherche en Epidémiologie et Santé des Populations, U1018 INSERM, Paris-Saclay Université, UVSQ, 94800 Villejuif, France
| | - Mireille Okassa
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
| | - Théodore Vinais
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
| | - Marilyne Lannaud
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
| | - Brigitte Plansont
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
| | - Alexandre Buisson
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
| | - Sandrine Guignandon
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
| | - Dominique Malauzat
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
| | - Murielle Girard
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
- INSERM, U1094 Institut d’Epidémiologie et de Neurologie Tropicale, Université de Limoges, CHU Limoges, IRD U270, GEIST, 87000 Limoges, France
| | - Benjamin Calvet
- Unité de Recherche et d’Innovation, Centre Hospitalier Esquirol, 87025 Limoges, France
- INSERM, U1094 Institut d’Epidémiologie et de Neurologie Tropicale, Université de Limoges, CHU Limoges, IRD U270, GEIST, 87000 Limoges, France
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Nobakhsh B, Shalbaf A, Rostami R, Kazemi R, Rezaei E, Shalbaf R. An effective brain connectivity technique to predict repetitive transcranial magnetic stimulation outcome for major depressive disorder patients using EEG signals. Phys Eng Sci Med 2023; 46:67-81. [PMID: 36445618 DOI: 10.1007/s13246-022-01198-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/06/2022] [Indexed: 11/30/2022]
Abstract
One of the most effective treatments for drug-resistant Major depressive disorder (MDD) patients is repetitive transcranial magnetic stimulation (rTMS). To improve treatment efficacy and reduce health care costs, it is necessary to predict the treatment response. In this study, we intend to predict the rTMS treatment response in MDD patients from electroencephalogram (EEG) signals before starting the treatment using machine learning approaches. Effective brain connectivity of 19-channel EEG data of MDD patients was calculated by the direct directed transfer function (dDTF) method. Then, using three feature selection methods, the best features were selected and patients were classified as responders or non-responders to rTMS treatment by using the support vector machine (SVM). Results on the 34 MDD patients indicated that the Fp2 region in the delta and theta frequency bands has a significant difference between the two groups and can be used as a significant brain biomarker to assess the rTMS treatment response. Also, the highest accuracy (89.6%) using the SVM classifier for the best features of the dDTF method based on the area under the receiver operating characteristic curve (AUC-ROC) criteria was obtained by combining the delta and theta frequency bands. Consequently, the proposed method can accurately detect the rTMS treatment response in MDD patients before starting treatment on the EEG signal to avoid financial and time costs to patients and medical centers.
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Affiliation(s)
- Behrouz Nobakhsh
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
| | - Reza Kazemi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Erfan Rezaei
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shalbaf
- Institute for Cognitive Science Studies, Tehran, Iran
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Liu Y, Lim K, Sundman MH, Ugonna C, Ton That V, Cowen S, Chou YH. Association Between Responsiveness to Transcranial Magnetic Stimulation and Interhemispheric Functional Connectivity of Sensorimotor Cortex in Older Adults. Brain Connect 2023; 13:39-50. [PMID: 35620910 PMCID: PMC9942174 DOI: 10.1089/brain.2021.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Repetitive transcranial magnetic stimulation (rTMS) is a promising therapeutic technique, and is believed to accomplish its effect by influencing the stimulated and remotely connected areas. However, responsiveness to rTMS shows high interindividual variability, and this intersubject variability is particularly high in older adults. It remains unclear whether baseline resting-state functional connectivity (rsFC) contributes to this variability in older adults. The aims of this study are to (1) examine rTMS effects over the primary motor cortex (M1) in older adults, and (2) identify baseline network properties that may contribute to the interindividual variability. Methods: We tested response to intermittent theta burst stimulation (iTBS), an effective rTMS protocol, over M1 by using both electromyography and resting-state functional magnetic resonance imaging in older adults. Outcome measures included motor-evoked potential (MEP) elicited by single-pulse transcranial magnetic stimulation and rsFC before and after an iTBS session. Results: iTBS significantly increased MEP amplitudes and rsFC between the stimulation site, sensorimotor cortex, and supplementary motor area (SMA) in older adults. iTBS-induced changes in MEP amplitude were positively correlated with increases in interhemispheric rsFC after iTBS. Furthermore, older adults with lower baseline interhemispheric rsFC between sensorimotor cortex and SMA exhibited stronger MEP response after iTBS. Discussion: Findings of the study suggest that different levels of interhemispheric communication during resting state might contribute to the response heterogeneity to iTBS in older adults. Interhemispheric rsFC may have great potential serving as a useful marker for predicting iTBS responsiveness in older adults. ClinicalTrials.gov ID: 1707654427 Impact statement Factors contributing to interindividual variability of the responsive to repetitive transcranial magnetic stimulation (rTMS) in older adults remain poorly understood. In this study, we examined the effects of rTMS over the primary motor cortex in older adults, and found that response to rTMS is associated with prestimulation interhemispheric connectivity in the sensorimotor and premotor areas. Findings of the study have great potential to be translated into a connectivity-based strategy for identification of responders for rTMS in older adults.
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Affiliation(s)
- Yilin Liu
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Koeun Lim
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Mark H. Sundman
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Chidi Ugonna
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, USA
| | - Viet Ton That
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
| | - Stephen Cowen
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, Arizona, USA
| | - Ying-hui Chou
- Department of Psychology and University of Arizona, Tucson, Arizona, USA
- Evelyn F McKnight Brain Institute, Arizona Center on Aging, and BIO5 Institute, University of Arizona, Tucson, Arizona, USA
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16
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Transcranial magnetic stimulation in the treatment of adolescent depression: a systematic review and meta-analysis of aggregated and individual-patient data from uncontrolled studies. Eur Child Adolesc Psychiatry 2022; 31:1501-1525. [PMID: 35751003 PMCID: PMC9532325 DOI: 10.1007/s00787-022-02021-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/01/2022] [Indexed: 12/31/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adolescent major depressive disorder (MDD). Existing evidence on the efficacy of TMS in adolescent MDD awaits quantitative synthesis. A systematic literature search was conducted, and data from eligible studies were synthesized using random-effects models. Treatment-covariate interactions were examined in exploratory analyses of individual-patient data (IPD). Systematic search of the literature yielded 1264 hits, of which 10 individual studies (2 randomized trials) were included for quantitative synthesis of mainly uncontrolled studies. Individual patient data (IPD) were available from five trials (all uncontrolled studies). Quantitative synthesis of aggregated data revealed a statistically significant negative overall standardized mean change (pooled SMCC = 2.04, 95% CI [1.46; 2.61], SE = 0.29, p < .001), as well as a significant overall treatment response rate (Transformed Proportion = 41.30%, 95% CI [31.03; 51.57], SE = 0.05; p < 0.001), considering data from baseline to post-treatment. Exploratory IPD analyses suggests TMS might be more effective in younger individuals and individuals with more severe depression, and efficacy might be enhanced with certain treatment modality settings, including higher number of TMS sessions, longer treatment durations, and unilateral and not bilateral stimulation. Existing studies exhibit methodological shortcomings, including small-study effects and lack of control group, blinding, and randomization-compromising the credibility of the present results. To date, two randomized controlled trials on TMS in adolescent depression have been published, and the only large-scale randomized trial suggests TMS is not more effective than sham stimulation. Future large-scale, randomized, and sham-controlled trials are warranted. Future trials should ensure appropriate selection of patients for TMS treatment and guide precision medicine approaches for stimulation protocols.
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Malhi GS, Bell E, Bassett D, Boyce P, Bryant R, Hazell P, Hopwood M, Lyndon B, Mulder R, Porter R, Singh AB, Murray G. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2021; 55:7-117. [PMID: 33353391 DOI: 10.1177/0004867420979353] [Citation(s) in RCA: 310] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To provide advice and guidance regarding the management of mood disorders, derived from scientific evidence and supplemented by expert clinical consensus to formulate s that maximise clinical utility. METHODS Articles and information sourced from search engines including PubMed, EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (e.g. books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Relevant information was appraised and discussed in detail by members of the mood disorders committee, with a view to formulating and developing consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous consultation and external review involving: expert and clinical advisors, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists mood disorders clinical practice guidelines 2020 (MDcpg2020) provide up-to-date guidance regarding the management of mood disorders that is informed by evidence and clinical experience. The guideline is intended for clinical use by psychiatrists, psychologists, primary care physicians and others with an interest in mental health care. CONCLUSION The MDcpg2020 builds on the previous 2015 guidelines and maintains its joint focus on both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Gin S Malhi (Chair), Erica Bell, Darryl Bassett, Philip Boyce, Richard Bryant, Philip Hazell, Malcolm Hopwood, Bill Lyndon, Roger Mulder, Richard Porter, Ajeet B Singh and Greg Murray.
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Affiliation(s)
- Gin S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia.,Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | | | - Philip Boyce
- Department of Psychiatry, Westmead Hospital and the Westmead Clinical School, Wentworthville, NSW, Australia.,Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Philip Hazell
- Discipline of Psychiatry, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne and Professorial Psychiatry Unit, Albert Road Clinic, Melbourne, VIC, Australia
| | - Bill Lyndon
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ajeet B Singh
- The Geelong Clinic Healthscope, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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18
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Current clinical practice of electroconvulsive therapy and repetitive transcranial magnetic stimulation in psychiatry, a German sample. Eur Arch Psychiatry Clin Neurosci 2021; 271:181-190. [PMID: 31996994 PMCID: PMC8179911 DOI: 10.1007/s00406-020-01099-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/13/2020] [Indexed: 12/28/2022]
Abstract
The purpose of the study was to evaluate the current clinical practice of Electroconvulsive Therapy and Repetitive Transcranial Magnetic Stimulation in German psychiatry. Case-based data (> 1.000.000 cases) were collected according to §21 of the German hospital remuneration law from January 2015 to December 2017. The study cohort comprises approximately 35-40% of the annual psychiatric cases and hospitals in Germany. Frequency of ECT and rTMS cases were investigated considering main diagnoses according to ICD-10 and treatment settings (inpatient vs. day-care). ECT cases with short-term hospitalization (≤ 4 days) were supposed to be maintenance ECT cases. A linear regression analysis was conducted to estimate trends in the use of ECT and rTMS. Different groups were compared using Chi-square tests. ECT and rTMS cases appear to increase in total during the observation period possibly due to facilities newly introducing ECT and rTMS but also to increased frequency of treatments. Both treatments were rarely performed in day-care settings (0.89% and 11.25%). ECT was performed in 1.72% of all cases with affective disorders and in 1.48% with major depressions, respectively. Age ≥ 65 years, females, severe and psychotic depression were significantly associated with a higher rate of ECT cases. > 40% of all ECT cases were possibly maintenance ECT cases. Only 0.60% of these were performed in day- care settings. rTMS was primarily performed in major depression (86,7% of all rTMS cases). This study suggests a growing demand for ECT and rTMS. Nevertheless, the use of ECT is still low compared to the high prevalence of treatment resistant depression. The use of rTMS is even lower and seems to be restricted to specialized institutions. Maintenance ECT is frequently carried out in an inpatient setting. Limitations of this study are the case- and group-based analysis, missing data on outpatient services and treatment sessions per case. Therefore, the database is not necessarily representative for the entire German healthcare system. Further studies are needed to verify the presented findings and should address the feasibility of ambulatory and day-care ECT services.
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Luan D, Zhao MG, Shi YC, Li L, Cao YJ, Feng HX, Zhang ZJ. Mechanisms of repetitive transcranial magnetic stimulation for anti-depression: Evidence from preclinical studies. World J Psychiatry 2020; 10:223-233. [PMID: 33134113 PMCID: PMC7582130 DOI: 10.5498/wjp.v10.i10.223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 02/05/2023] Open
Abstract
This review summarizes the anti-depressant mechanisms of repetitive transcranial magnetic stimulation in preclinical studies, including anti-inflammatory effects mediated by activation of nuclear factor-E2-related factor 2 signaling pathway, anti-oxidative stress effects, enhancement of synaptic plasticity and neurogenesis via activation of the endocannabinoid system and brain derived neurotrophic factor signaling pathway, increasing the content of monoamine neurotransmitters via inhibition of Sirtuin 1/monoamine oxidase A signaling pathway, and reducing the activity of the hypothalamic-pituitary-adrenocortical axis. We also discuss the shortcomings of transcranial magnetic stimulation in preclinical studies such as inaccurate positioning, shallow depth of stimulation, and difficulty in elucidating the neural circuit mechanism up- and down-stream of the stimulation target brain region.
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Affiliation(s)
- Di Luan
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ming-Ge Zhao
- Department of Nursing, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ya-Chen Shi
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ling Li
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Yu-Jia Cao
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Hai-Xia Feng
- Department of Nursing, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Zhi-Jun Zhang
- Department of Neurology, Affiliated Zhongda Hospital, Research Institution of Neuropsychiatry, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Psychology, Xinxiang Medical University, Xinxiang 453003, Henan Province, China
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou 310013, Zhejiang province, China
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20
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Baliga SP, Mehta UM, Naik SS, Thanki MV, Mitra S, Arumugham SS, Kesavan M, Thirthalli J. A chart-based study of theta burst stimulation for depression at a tertiary care center. Brain Stimul 2020; 13:1606-1608. [PMID: 32987174 DOI: 10.1016/j.brs.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/03/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sachin Pradeep Baliga
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Milind Vijay Thanki
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Sayantanava Mitra
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, 560029, India
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21
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Bulteau S, Laurin A, Volteau C, Dert C, Lagalice L, Schirr-Bonnans S, Bukowski N, Guitteny M, Simons L, Cabelguen C, Pichot A, Tessier F, Bonnin A, Lepage A, Vanelle JM, Sauvaget A, Riche VP. Cost-utility analysis of curative and maintenance repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant unipolar depression: a randomized controlled trial protocol. Trials 2020; 21:312. [PMID: 32248820 PMCID: PMC7133008 DOI: 10.1186/s13063-020-04255-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/14/2020] [Indexed: 12/28/2022] Open
Abstract
Background Depression is a debilitating and costly disease for our society, especially in the case of treatment-resistant depression (TRD). Repetitive transcranial magnetic stimulation (rTMS) is an effective adjuvant therapy in treatment-resistant unipolar and non-psychotic depression. It can be applied according to two therapeutic strategies after an initial rTMS cure: a further rTMS cure can be performed at the first sign of relapse or recurrence, or systematic maintenance rTMS (M-rTMS) can be proposed. TMS adjuvant to treatment as usual (TAU) could improve long-term prognosis. However, no controlled study has yet compared the cost-effectiveness of these two additional rTMS therapeutic strategies versus TAU alone. Methods/design This paper focuses on the design of a health-economic, prospective, randomized, double-blind, multicenter study with three parallel arms carried out in France. This study assesses the cost-effectiveness of the adjunctive and maintenance low frequency rTMS on the right dorsolateral prefrontal cortex versus TAU alone. A total of 318 patients suffering from a current TRD will be enrolled. The primary endpoint is to investigate the incremental cost-effectiveness ratio (ICER) (ratio costs / quality-adjusted life-years [QALY] measured by the Euroqol Five Dimension Questionnaire) over 12 months in a population of patients assigned to one of three arms: systematic M-rTMS for responders (arm A); additional new rTMS cure in case of mood deterioration among responders (arm B); and a placebo arm (arm C) in which responders are allocated in two subgroups: sham systematic M-rTMS and supplementary rTMS course in case of mood deterioration. ICER and QALYs will be compared between arm A or B versus arm C. The secondary endpoints in each three arms will be: ICER at 24 months; the cost-utility ratio analysis at 12 and 24 months; 5-year budget impact analysis; and prognosis factors of rTMS. The following criteria will be compared between arm A or B and arm C: rates of responders; remission and disease-free survival; clinical evolution; tolerance; observance; treatment modifications; hospitalization; suicide attempts; work stoppage; marital / professional statues; and quality of life at 12 and 24 months. Discussion The purpose of our study is to check the cost-effectiveness of rTMS and we will discuss its economic impact over time. In the case of significant decrease in the depression costs and expenditures associated with a good long-term prognosis (sustained response and remission) and tolerance, rTMS could be considered as an efficient treatment within the armamentarium for resistant unipolar depression. Trial registration ClinicalTrials.gov, NCT03701724. Registered on 10 October 2018. Protocol Amendment Version 2.0 accepted on 29 June 2019.
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Affiliation(s)
- Samuel Bulteau
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France.
| | - Andrew Laurin
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Cécile Dert
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Lydie Lagalice
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Nicolas Bukowski
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Marie Guitteny
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Luc Simons
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | - Anne Pichot
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Fabienne Tessier
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Annabelle Bonnin
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | - Adeline Lepage
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
| | | | | | | | - Anne Sauvaget
- Centre Hospitalier Universitaire de Nantes, F-44000, Nantes, France
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22
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Vlcek P, Bares M, Novak T, Brunovsky M. Baseline Difference in Quantitative Electroencephalography Variables Between Responders and Non-Responders to Low-Frequency Repetitive Transcranial Magnetic Stimulation in Depression. Front Psychiatry 2020; 11:83. [PMID: 32174854 PMCID: PMC7057228 DOI: 10.3389/fpsyt.2020.00083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depressive disorder, with outcomes approaching 45-55% response and 30-40% remission. Eligible predictors of treatment outcome, however, are still lacking. Few studies have investigated quantitative electroencephalography (QEEG) parameters as predictors of rTMS treatment outcome and none of them have addressed the source localization techniques to predict the response to low-frequency rTMS (LF rTMS). We investigated electrophysiological differences based on scalp EEG data and inverse solution method, exact low-resolution brain electromagnetic tomography (eLORETA), between responders and non-responders to LF rTMS in resting brain activity recorded prior to the treatment. Twenty-five unmedicated depressive patients (mean age of 45.7 years, 20 females) received a 4-week treatment of LF rTMS (1 Hz; 20 sessions per 600 pulses; 100% of the motor threshold) over the right dorsolateral prefrontal cortex. Comparisons between responders (≥50% reduction in Montgomery-Åsberg Depression Rating Scale score) and non-responders were made at baseline for measures of eLORETA current density, spectral absolute power, and inter-hemispheric and intra-hemispheric EEG asymmetry. Responders were found to have lower current source densities in the alpha-2 and beta-1 frequency bands bilaterally (with predominance on the left side) in the inferior, medial, and middle frontal gyrus, precentral gyrus, cingulate gyrus, anterior cingulate, and insula. The most pronounced difference was found in the left middle frontal gyrus for alpha-2 and beta-1 bands (p < 0.05). Using a spectral absolute power analysis, we found a negative correlation between the absolute power in beta and theta frequency bands on the left frontal electrode F7 and the change in depressive symptomatology. None of the selected asymmetries significantly differentiated responders from non-responders in any frequency band. Pre-treatment reduction of alpha-2 and beta-1 sources, but not QEEG asymmetry, was found in patients with major depressive disorder who responded to LF rTMS treatment. Prospective trials with larger groups of subjects are needed to further validate these findings.
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Affiliation(s)
- Premysl Vlcek
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Bares
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Tomas Novak
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Brunovsky
- National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
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23
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Bulteau S, Guirette C, Brunelin J, Poulet E, Trojak B, Richieri R, Szekely D, Bennabi D, Yrondi A, Rotharmel M, Bougerol T, Dall’Igna G, Attal J, Benadhira R, Bouaziz N, Bubrovszky M, Calvet B, Dollfus S, Foucher J, Galvao F, Gay A, Haesebaert F, Haffen E, Jalenques I, Januel D, Jardri R, Millet B, Nathou C, Nauczyciel C, Plaze M, Rachid F, Vanelle JM, Sauvaget A. Troubles de l’humeur : quand recourir à la stimulation magnétique transcrânienne ? Presse Med 2019; 48:625-646. [DOI: 10.1016/j.lpm.2019.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/30/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
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24
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Kar SK. Predictors of Response to Repetitive Transcranial Magnetic Stimulation in Depression: A Review of Recent Updates. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2019; 17:25-33. [PMID: 30690937 PMCID: PMC6361049 DOI: 10.9758/cpn.2019.17.1.25] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/22/2018] [Accepted: 06/14/2018] [Indexed: 12/29/2022]
Abstract
Transcranial magnetic stimulation (TMS) has been increasingly used in the treatment of various neuropsychiatric disorders including depression over the past two decades. The responses to treatment with TMS are variable as found in the recent studies. Evidences suggest that various factors influence the outcome of depression treated with TMS. Understanding the predictors of response to TMS treatment in depression will guide the clinician in appropriate selection of patients for TMS treatment as well as needful modification in the TMS technique and protocol to have a better clinical outcome. This article comprehensively reviews the factors that predict the outcome of TMS treatment in depression.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, India
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25
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Association of the loudness dependence of auditory evoked potentials with clinical changes to repetitive transcranial magnetic stimulation in patients with depression. J Affect Disord 2018; 238:451-457. [PMID: 29920440 DOI: 10.1016/j.jad.2018.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/09/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although the application of repetitive transcranial magnetic stimulation (rTMS) for treatment of depression has been well investigated, there are few biological predictors of clinical outcomes to rTMS treatment. Previous studies have suggested that the loudness dependence of auditory evoked potentials (LDAEP) can be used as a predictor of response to antidepressant treatment. However, little is known about the association between rTMS and LDAEP. The present study aimed to investigate whether baseline LDAEP is associated with clinical changes to rTMS treatment in patients with major depressive disorder (MDD), and to explore the effect of high-frequency rTMS on LDAEP. METHODS Thirty patients were randomized to receive 15 sessions of active (n = 15) or sham rTMS (n = 15). LDAEP and clinical measures of depression were assessed before and after 10 Hz rTMS treatment for 15 days. RESULTS Baseline LDAEP was associated with changes in scores on the Hamilton Rating Scale for Depression. There were no significant effects of rTMS on LDAEP. Patients with high LDAEP exhibited more favorable clinical changes than those with low LDAEP following treatment with rTMS. LIMITATIONS The sample was relatively small, and the participants were not divided into responders and non-responders group due to small sample. An influence of medication has not been controlled. CONCLUSIONS Our findings suggest that high baseline LDAEP may be associated with favorable clinical changes to rTMS treatment in patients with MDD. Further studies are required to replicate and validate the potential use of LDAEP as a predictor of clinical changes to rTMS treatment.
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Rostami R, Kazemi R, Nitsche MA, Gholipour F, Salehinejad MA. Clinical and demographic predictors of response to rTMS treatment in unipolar and bipolar depressive disorders. Clin Neurophysiol 2017; 128:1961-1970. [PMID: 28829979 DOI: 10.1016/j.clinph.2017.07.395] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/28/2017] [Accepted: 07/03/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Previous studies investigated predictors of repetitive transcranial magnetic stimulation (rTMS) response in depressive disorders but there is still limited knowledge about clinical predictors. Moreover, predictors of rTMS response in bipolar depression (BDD) are less studied than unipolar depression (UDD). METHODS We performed a binary logistic regression analysis in 248 patients with depressive disorders (unipolar N=102, bipolar N=146) who received 20 sessions of DLPFC rTMS (High-frequency rTMS, low-frequency rTMS, bilateral rTMS) to investigate significant clinical and demographic predictors of rTMS response. We also investigated effects of depression type, response (yes, no) and time on reducing somatic and cognitive-affective symptoms of patients. RESULTS Depression type (unipolar vs. bipolar) did not have a significant effect on rTMS response. 45% of all patients, 51.5% of UDD patients and 41% of BDD patients, responded to rTMS treatment. Age was the only significant demographic predictor of treatment response in all patients. Cognitive-affective symptoms, compared to somatic symptoms were significant predictors for treatment response to rTMS. Common and unique clinical predictor for UDD and BDD were identified. CONCLUSIONS Younger patients and those with cognitive-affective rather than somatic symptoms benefit more from DLPFC rTMS treatment. rTMS is effective in UDD and BDD patients. Patients should be selected based on clinical and demographic profile. SIGNIFICANCE Findings are based on the largest thus far reported sample of patients with depressive disorders that received DLPFC rTMS.
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Affiliation(s)
- Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran; Atieh Clinical Neuroscience Centre, Tehran, Iran.
| | - Reza Kazemi
- Atieh Clinical Neuroscience Centre, Tehran, Iran.
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; University Medical Hospital Bergmannsheil, Department of Neurology, Bochum, Germany.
| | | | - M A Salehinejad
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran; Atieh Clinical Neuroscience Centre, Tehran, Iran.
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