Abstract
Repeated transcranial magnetic stimulation (rTMS) is a therapeutic brain-stimulation technique that is particularly used for drug-resistant depressive disorders. European recommendations mention the effectiveness of 30 to 64%. The failure rate of treatment is high and clinical improvement is visible only after a certain period of time. It would thus be useful to have indicators that could anticipate the success of treatment and more effectively guide therapeutic choices. We aimed to find predictive indicators of clinical improvement at 1 month after the start of rTMS treatment among the data collected during the care of patients with drug-resistant depression included in the Neuromodulation Unit of the Esquirol Hospital in Limoges since 2007. In total, 290 patients with a pharmaco-resistant depressive episode, according to the Hamilton Depression Rating Scale (HDRS) (score ≥8), before treatment who underwent a complete course of rTMS treatment and did not object to the use of their collected data were included. The clinical response in routine practice, corresponding to a decrease in the HDRS score of at least 50% from inclusion, was determined and complemented by interquartile analysis. A combination of factors predictive of clinical response during care, such as a short duration of the current depressive episode associated with a higher HDRS agitation item value (or a lower perceived sleepiness value) and a higher number of previous rTMS treatments, were identified as being useful in predicting the efficacy of rTMS treatment in routine clinical practice, thus facilitating the therapeutic choice for patients with drug-resistant depression.
Highlights
Repeated transcranial magnetic stimulation, based on the principle of electromagnetic induction, is a brain-stimulation technique developed in the 1980s for the purpose of electrophysiological exploration
- patients over 18 years of age with a diagnosis of uni- or bipolar depression, according to the DSM-IV-TR and DSM-5 criteria since 2016: patients with the bipolar affective disorder (F31 ICD-10), depressive episodes (F32 ICD-10), recurrent depressive disorder (F33 ICD-10), or persistent [affective] mood disorders (F34 ICD-10). - patients with depressive episode characterized by an Hamilton Depression Rating Scale (HDRS) score ≥8 at D0 and drug-resistant, i.e., the failure of at least two drug treatments prior to their treatment with Repeated transcranial magnetic stimulation (rTMS)
We distinguished between patients with so-called mild depression, with an HDRS score between 8 and 15, and those with major depression, with an HDRS score ≥16. - patients undergoing a complete course of rTMS treatment comprised of five sessions per week for 3 weeks associated with three follow-ups on D0, D15, and M1
Summary
Repeated transcranial magnetic stimulation (rTMS), based on the principle of electromagnetic induction, is a brain-stimulation technique developed in the 1980s for the purpose of electrophysiological exploration. In clinical practice, the first-line treatment for depressive disorder (excluding bipolar disorder) is still the use of antidepressants (such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs)), alone or in combination with psychotherapy. Their effectiveness is between 40 and 50%, depending on the criteria used. A poor response to antidepressant therapies is one of the risk factors for developing chronic depression. The management of such resistant depressive episodes is, an important issue. The therapeutic strategy in situations of nonresponse to the first line of treatment is still unclear, as is the strategy after failure of the second line of treatment
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