Abstract
Abstract Introduction Deep Transcranial Magnetic Stimulation (dTMS) is an FDA-approved non-invasive brain stimulation treatment for management of treatment-resistant depression (TRD). However, the efficacy of dTMS on Insomnia, a commonly prevalent and one of the most refractory symptoms of depression, is not clearly established. Our study aims to assess the impact of dTMS on outcomes of insomnia comorbid with TRD. Methods Single center retrospective study examining mood and insomnia outcomes in TRD patients (n=25), with greater than 3 failed psychotropic medication trials, undergoing dTMS for unipolar major depression.. Questionnaires including Patient Health Questionnaire (PHQ-9), Insomnia Severity Index (ISS),Generalized Anxiety Disorder-7 (GAD-7) were compared at baseline and at the end of dTMS treatment course. Results TRD patients with ‘low insomnia’ (n=12; ISS=7.9) and ‘high insomnia’ (n=13; ISS=20) were examined in terms of mood and insomnia ouctomes. No significant differences at baseline were noted between two groups in terms of demographic, mood, and anxiety variables. Depression and anxiety symptoms for patients in ‘Low Insomnia’ group significantly improved from baseline to final dTMS session- PHQ-9 [t(11) = 6.021, p < .0001]], GAD-7 [t(11) = 2.389, p = .036]. TRD patients in ‘High Insomnia’ group also reported significant improvements in depression [t(12) = 5.596, p < .0001], anxiety [t(12) = 2.743, p = .018], and insomnia [t(12) = 6.057, p < .0001]] at final dTMS session as compared to baseline. Non-responders in ‘High Insomnia’ group did not achieve statistically significant improvements in either depression or insomnia outcomes. Conclusion Insomnia comorbid with TRD responds to treatment with dTMS irrespective of the insomnia severity at baseline. Prospective research with the use of objective assessment measures for insomnia is warranted to confirm these findings. Non-response to insomnia was associated with poor mood outcomes as well in TRD patients. The probable mechanistic action of insomnia improvement in patients with TRD undergoing dTMS is unclear and further systematic research to understand the clinical and neural correlates of insomnia response with dTMS is needed. Support (if any) N/A
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