Reduction in Obsessive-Compulsive and Depressive Symptoms Following Bilateral Repetitive Transcranial Magnetic Stimulation (rTMS): Case Series

Abstract

s / Brain Stimulation 7 (2014) e17ee26 e21 Objective: We sought to examine the time course of rTMS augmentation of medication in 54 psychiatric outpatients with treatment resistant depression. Methods: rTMS was administered with the Neurostar device. The standard protocol was 3000 pulses at 10 or 20 Hz at 120% motor threshold (MT) on the left dorsolateral prefrontal cortex (DLPFC) for the treatment of depression. A subset of patients (n1⁄433) also received 2000 pulses at 1 Hz at 80% MT on the right DLPFC for the treatment of anxiety. A retrospective chart review was preformed to assess progress after both ten and twenty treatments using the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Results: Mean BDI-II scores were 25.6 (SD1⁄411.2) at baseline, 14.6 (SD1⁄411.7) after 10 treatments, and 11.0 (SD1⁄410.3) after 20 treatments. Scores were significantly reduced on the BDI-II, t(53)1⁄4 8.05, p < 0.001 between baseline and 10 treatments and between baseline and 20 treatments BDI-II t(31)1⁄48.40, p < 0.001. Mean scores on the BAI were 18.8 (SD1⁄411.2) at baseline, 10.2 (SD1⁄49.8) after 10 treatments, and 8.2 (SD1⁄48.4) after 20 treatments. Significant differences emerged on the BAI between baseline and 10 treatments, t(51)1⁄4 6.36, p < 0.001 and between baseline and 20 treatments BAI t(30)1⁄4 6.78, p < 0.001. Conclusions: Our research suggests that most patients experienced a significant reduction in anxiety and depression in as little at 10 treatments. Supported by a grant from Neuronetics, Inc. Clinical trial posted on www.clinicaltrials.gov, listing number NCT 01114477 13 Reduction in Obsessive-Compulsive and Depressive Symptoms Following Bilateral Repetitive Transcranial Magnetic Stimulation (rTMS): Case Series Veronica Holland LaSalle-Ricci PhD , Elyssa Sisko BA , Laura DeLuca MD , Mark DeLuca MD , Heather Allsup AAS , Kristie DeBlasio PhD , Aron Tendler MD C.BSM a,c Advanced Mental Health Care Inc b Private Practice c Presenting Author Background: High frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) has demonstrated efficacy and is FDA approved for depression. Low frequency rTMS to the right DLPFC has antidepressant activity in a subset of patients, and is immediately anxiolytic though this effect has not been shown to be sustainable. Objective: We combined high frequency rTMS to the left DLPFC with low frequency rTMS to the right DLPFC in 12 patients diagnosed with comorbid treatment resistant depression and obsessive-compulsive disorder (OCD) as an augmentation to medication. Methods: rTMS was administered with the Neurostar device. Patients first received 2000 pulses at 1 Hz at 80% motor threshold (MT) on the right DLPFC followed by 3000 pulses at 10 or 20 Hz at 120% MT on the left DLPFC. Patients were assessed at baseline, 10 treatments, and 20 treatments using the Yale-Brown ObsessiveCompulsive Inventory (YBOCS) and the Beck Depression InventoryII (BDI-II). Results: Patients experienced a decline in BDI-II scores from baseline (mean1⁄429.0, SD1⁄411.7), to 10 treatments (mean1⁄417.0, SD1⁄414.7), and to 20 treatments (mean1⁄410.8, SD1⁄413.5). Scores were significantly reduced on the BDI-II between baseline and 10 treatments (BDI-II t(12)1⁄44.6, p<0.001), as well as between baseline and 20 treatments (BDI-II t(10)1⁄48.4, p< 0.001). YBOCS scores also decreased from baseline (mean1⁄420.8, SD1⁄48.9), to 10 treatments (mean1⁄417.6, SD1⁄4 6.9), and to 20 treatments (mean1⁄411.1, SD1⁄47.6). No significant difference occurred between baseline and 10 treatments (t(12)1⁄41.3, p1⁄40.1), but significant differences emerged between baseline and 20 treatments (t(10)1⁄43.5, p1⁄40.004). Conclusions: Bilateral rTMS may be an effective treatment for patients with comorbid depression and OCD.