Abstract
BackgroundRepetitive Transcranial Magnetic Stimulation (rTMS) is commonly administered to Major Depressive Disorder (MDD) patients taking psychotropic medications, yet the effects on treatment outcomes remain unknown. We explored how concomitant medication use relates to clinical response to a standard course of rTMS.MethodsMedications were tabulated for 181 MDD patients who underwent a six‐week rTMS treatment course. All patients received 10 Hz rTMS administered to left dorsolateral prefrontal cortex (DLPFC), with 1 Hz administered to right DLPFC in patients with inadequate response to and/or intolerance of left‐sided stimulation. Primary outcomes were change in Inventory of Depressive Symptomatology Self Report (IDS‐SR30) total score after 2, 4, and 6 weeks.ResultsUse of benzodiazepines was associated with less improvement at week 2, whereas use of psychostimulants was associated with greater improvement at week 2 and across 6 weeks. These effects were significant controlling for baseline variables including age, overall symptom severity, and severity of anxiety symptoms. Response rates at week 6 were lower in benzodiazepine users versus non‐users (16.4% vs. 35.5%, p = 0.008), and higher in psychostimulant users versus non‐users (39.2% vs. 22.0%, p = 0.02).ConclusionsConcomitant medication use may impact rTMS treatment outcome. While the differences reported here could be considered clinically significant, results were not corrected for multiple comparisons and findings should be replicated before clinicians incorporate the evidence into clinical practice. Prospective, hypothesis‐based treatment studies will aid in determining causal relationships between medication treatments and outcome.
Highlights
Repetitive Transcranial Magnetic Stimulation has gained increasingly widespread clinical use for treatment of Major Depressive Disorder (MDD) since it was approved in the US in 2008 for treatment of antidepressant drug‐resistant unipolar major depression
The present study explored associations between concomi‐ tant medications and Repetitive Transcranial Magnetic Stimulation (rTMS) outcome during treatment of MDD
The present results suggest that BDZ use is associated with less improvement early in the course of rTMS
Summary
Repetitive Transcranial Magnetic Stimulation (rTMS) has gained increasingly widespread clinical use for treatment of Major Depressive Disorder (MDD) since it was approved in the US in 2008 for treatment of antidepressant drug‐resistant unipolar major depression. Initial trials examined the efficacy of rTMS monotherapy for MDD (George et al, 2010; Levkovitz et al, 2015; O'Reardon et al, 2007), in clinical practice physicians typically ad‐ minister rTMS as an augmentation therapy, rather than discontinue a patient's current medications. The present study explored associations between concomi‐ tant medications and rTMS outcome during treatment of MDD. The motivation for this investigation was twofold: first, to exam‐ ine evidence that could help inform clinical decision‐making when addressing the integration of psychopharmacology with rTMS; and second, to identify those medication mechanisms of action (MOAs) that might help elucidate which classes of psychotropic drugs are most likely to interact with rTMS effects. We examined the effect of standard medication classes on treatment outcome in 181 patients receiving a standard clinical course of rTMS. Results identified categories of medication use that were associ‐ ated with greater or lesser clinical improvement over the course of rTMS
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
