Abstract
Background: Mindfulness-Based Cognitive Therapy (MBCT) has been shown to enhance the long-term treatment outcomes for major depressive disorder (MDD), and engagement of specific brain activities during brain stimulation may produce synergistic effects. Audio-guided meditation exercises are a component of MBCT that might be combined with standard transcranial magnetic stimulation (TMS) therapy sessions. We developed and pilot-tested a modified MBCT protocol for patients undergoing a standard course of TMS for MDD.Methods: Four MBCT audiotracks with differing durations and types of mental focus were selected. Patients listened to the audiotapes through headphones during daily TMS sessions for 5 consecutive weeks. The primary goal was to evaluate the feasibility and acceptability of the meditation intervention with TMS. Changes in self-rated measures of symptom severity, stress, life satisfaction, and mindfulness were also assessed.Results: Seventeen depressed subjects completed the study and 12 terminated early. Reasons for discontinuation included an inability to meditate in the treatment setting and induction of negative mood states. TMS percussive sensations and clicking sounds hindered the ability of patients to fully concentrate on or hear the voice of the audiotape narrator. Some became overwhelmed or felt increased pressure, anxiety, or aggravation trying to do meditation exercises while receiving TMS.Conclusion: There is a growing interest in combining TMS with other concurrent psychotherapeutic interventions to optimize treatment outcomes. The results highlight numerous feasibility issues with MBCT via guided audiotapes during TMS treatment. Future work should draw on these shortcomings to evaluate the appropriateness of MBCT for depressed patients undergoing neuromodulation.
Highlights
Major depressive disorder (MDD) has a 16% lifetime prevalence (Kessler and Bromet, 2013) among the world population
To represent the range of environments and patient samples where Repetitive TMS (rTMS)/Mindfulness-Based Cognitive Therapy (MBCT) might eventually be used, we evaluated the feasibility in two different Transcranial magnetic stimulation (TMS) treatment settings, and we did not place any constraints on the specific stimulation protocol the psychiatrist prescribed for depressed patients receiving treatment in their clinic
Among these study demographics and treatment features, only baseline IDSSR depression severity significantly differed between study sites (Butler Hospital: 47 ± 11; Salience: 37 ± 10. p = 0.03, t = 2.29); patients at the Butler site were more symptomatic at the start of their course of TMS therapy
Summary
Major depressive disorder (MDD) has a 16% lifetime prevalence (Kessler and Bromet, 2013) among the world population. Repetitive TMS (rTMS) therapy is an FDA-approved intervention for MDD based on sham-controlled clinical trials where the stimulation of the left dorsolateral prefrontal cortex (L-DLPFC) over 4–6 weeks demonstrated efficacy in patients whose symptoms were not relieved by traditional antidepressant medications (George et al, 2000; O’Reardon et al, 2007). Mindfulness-Based Cognitive Therapy (MBCT) has been shown to enhance the long-term treatment outcomes for major depressive disorder (MDD), and engagement of specific brain activities during brain stimulation may produce synergistic effects. Audio-guided meditation exercises are a component of MBCT that might be combined with standard transcranial magnetic stimulation (TMS) therapy sessions.
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