Abstract
Background: Repetitive transcranial magnetic stimulation (rTMS) is considered an efficacious non-invasive neuromodulation treatment for major depressive disorder (MDD). However, little is known about the clinical outcome of combined rTMS and psychotherapy (rTMS + PT). Through common neurobiological brain mechanisms, rTMS + PT may exert enhanced antidepressant effects compared to the respective monotherapies. Objective: The current naturalistic study aimed to evaluate feasibility and clinical outcome of rTMS + PT in a large group of MDD patients. The second aim was to identify clinical predictors of response and remission. Methods: A total of 196 patients with MDD were treated with at least 10 sessions of simultaneous rTMS and PT. rTMS was applied over the DLPFC, either 10 Hz left or 1 Hz right. Psychotherapy was based on principles of cognitive behavioral therapy (CBT). Symptoms were measured using the BDI each fifth session until end of treatment and at 6-month follow-up. Comparisons were made between responders and non-responders, as well as between the 10 Hz and 1 Hz protocol. Additionally, baseline variables and early BDI change were evaluated as predictors of response/remission. Major findings and conclusions: 1) Combining rTMS and PT resulted in a 66% response and a 56% remission rate at the end of treatment with 60% sustained remission at follow-up. Compared to previous findings in RCTs, these rates are relatively high; 2) No differences were found between the 10 Hz and 1 Hz TMS regarding clinical outcome; 3) Clinical baseline variables were not predictive of treatment outcomes; 4) Early symptom improvement (at session 10) was highly predictive of response, and may therefore be used to guide rTMS + PT continuation; 5) Based on the current findings in a large naturalistic study, future studies employing a more standardized method are warranted to draw solid conclusions on the unique effect of rTMS + PT.
| Original language | English |
|---|---|
| Pages (from-to) | 337-345 |
| Journal | Brain stimulation |
| Volume | 11 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Mar 2018 |
Funding
MA reports options from Brain Resource (Sydney, Australia); he is director and owner of Research Institute Brainclinics, a minority shareholder in neuroCare Group (Munich, Germany), and a co-inventor on 4 patent applications (A61B5/0402; US2007/0299323, A1; WO2010/139361 A1) related to EEG, neuromodulation and psychophysiology, but does not own these nor receives any proceeds related to these patents; Research Institute Brainclinics received funding from Brain Resource (Sydney, Australia) and neuroCare Group (Munich, Germany) , and equipment support from Deymed, neuroConn and Magventure, however data analyses and writing of this manuscript were unconstrained. AJR reports consulting fees from the American Psychiatric Association, Brain Resource Ltd., Compass Inc., Curbstone Consultant LLC., Eli Lilly, Emmes Corp., Liva-Nova, Lundbeck A/S, National Institute of Drug Abuse, Taj Medical, Santium Inc., Sunovion, Taj Medical, Takeda USA; speaking fees from Live Nova; royalties from Guilford Publications and the University of Texas Southwestern Medical Center. FP has received speaker's honorarium from Mag&More GmbH (Munich, Germany) and the neuroCare Group (Munich, Germany) as well as support with equipment from the neuroCare Group, Mag&More GmbH and Brainsway Inc. (Jerusalem, Israel).
Keywords
- Clinical predictors
- Cognitive-behavioral therapy (CBT)
- Major depressive disorder (MDD)
- Repetitive transcranial magnetic stimulation (rTMS)
- Treatment outcome