Abstract
Abstract Repetitive transcranial magnetic stimulation (rTMS) as a treatment in major depressive disorder (MDD) conventionally targets the dorsolateral prefrontal cortex (DLPFC). It is deemed clinically effective, yet there is still at least 44% of MDD patients not achieving remission. 1 Hz right orbitofrontal cortex (OFC) stimulation was developed as a relatively new target for rTMS treatment, based on, and adding to the theory of its role in ”non-reward” signaling in MDD. A first study shows a response rate of 30% (at least 50% reduction of MDD symptoms) in those not responding to dorsomedial prefrontal cortex targeted rTMS in an earlier stage (Feffer et al., 2018). Implementing this experimental protocol, we offered 1 Hz OFC TMS to 16 patients with MDD in two outpatient clinics in the Netherlands. Their complete rTMS treatment consisted of 75 sessions on average, of which 30 sessions were OFC targeted. The average moment of switch to OFC TMS was after 44 sessions of DLPFC stimulation. The average age was 53.5 years (SD = 13.0) and 54% are female. Collected data includes clinical history, medication, stimulation parameters, and illness severity over the course of treatment, based on a self-rated symptom scale and clinical evaluation. Through these and other additional data, we will investigate response and remission in this sample and predictive factors of treatment success, developing stratification methods based on baseline EEG and psychological factors. Given clinically observed behavior in OFC TMS responders, we hypothesize that patients can be stratified to OFC TMS in an earlier stage, hopefully aiding to battle depression treatment resistance. Feffer, K., Fettes, P., Giacobbe. P., Daskalakis, Z.J., Blumberger, D.M., Downar, J., 2018. 1 Hz rTMS of the right orbito frontal cortex for major depression: Safety, tolerability and clinical outcomes. European Neuropsychopharmacology, 28, 109-117. https://doi.org/10.1016/j.euroneuro.2017.11.011 Keywords: OFC TMS, Depression, Treatment stratification, rTMS
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