Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a neurostimulatory technique used to modulate orbital frontal corticostriatal (OFC) activity and clinical symptomatology for psychiatric disorders involving OFC dysfunction. We examined the effectiveness of rTMS in the treatment of major depressive disorder in an applied clinical setting (Awakening KC CNI) to assess efficacy and optimize rTMS parameters within clinical practice. A retrospective review of medical records was carried out on patients with major depressive disorder undergoing rTMS therapy at Awakenings KC Clinical Neuroscience Institute (CNI), a suburban tertiary psychiatric clinic. A detailed de-identified data set of clinical outcomes was compiled. Patient Health Questionnaire 9 (PHQ-9) total score, clinical remission rate and week achieved were evaluated over 6 weeks of treatment to assess clinical response referencing two different rTMS instruments (MagVenture; NeuroStar). Our survey included 247 participants from males (N=98) and females (N=149) with average baseline PHQ-9 scores of 21.7±4, classified as severe depression. Clinically rated remission rates of 72% were achieved in 3.1±1.0 weeks and associated with prior history of psychiatric hospitalization, suicide attempts and substance use disorder. Average baseline PHQ- 9 scores decreased significantly over time with proportionately greater remission rates achieved for patients treated using the MagVenture over NeuroStar instrument. rTMS in applied clinical practice is efficacious over a wide range of settings and patients. Clinical response was related to severity of depression symptoms (e.g., prior hospitalization; suicide attempts) validating efficacy in critically ill groups. Clinical response may be impacted by rTMS instrument, magnetic field parameters or individual factors.
Highlights
Major Depressive Disorder (MDD) has a complex etiology with neurobiological deregulation of cellular signaling involving select brain regions and neurotransmitter systems (Knowland and Lim;[1] Post and Warden[2] for reviews)
We evaluated the effectiveness of Repetitive transcranial magnetic stimulation (rTMS) and Cognitive Behavioral Therapy (CBT) combined with rTMS in the treatment of MDD and other related psychiatric comorbidities and conditions in an applied clinical setting (AwakeningsKC, Clinical Neuroscience Institute (CNI))
Average Patient Health Questionnaire 9 (PHQ-9) score at baseline was 21.7±4 classified as severe depression which did not differ by gender, prior suicide attempt or inpatient psychiatric hospitalization
Summary
Major Depressive Disorder (MDD) has a complex etiology with neurobiological deregulation of cellular signaling involving select brain regions and neurotransmitter systems (Knowland and Lim;[1] Post and Warden[2] for reviews). Disturbances in several specific neurotransmitters [e.g., serotonin (5-HT), dopamine (DA), and norepinephrine (NE)] have been associated with MDD diagnosis and reports of depressive symptoms.[1] These systems are targeted by medications that treat MDD which modulate their activity at the synaptic level. Kessler et al.[3] found approximately 14 million adults meeting the diagnostic criteria for Major Depressive Disorder (MDD) with only half receiving treatment. According to a 2017 report from the National Institute of Mental Health, approximately 16.2 million adults (6.7% of adults) reported at least one depressive episode in the last year emphasizing the need for an alternative treatment method for MDD
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