Abstract
We previously examined the efficacy of rTMS for major depressive disorder in an applied clinical practice. Clinical response was related to severity of depression as well as the rTMS instrument utilized suggesting a relationship to instrument or magnetic field parameters and individual factors. The effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the treatment of major depressive disorder was further evaluated using Log-Rank statistics for time to remission outcomes. A follow-up retrospective medical records study was carried out on patients with major depressive disorder undergoing rTMS therapy at AwakeningsKC Clinical Neuroscience Institute (CNI), a suburban tertiary psychiatric clinic. Cox Proportional Hazard with Log-Rank statistics were applied and the time course to clinical remission was evaluated over a 6-week period with respect to age, gender, and depression severity. Clinical response was observed referencing two different rTMS instruments (MagVenture; NeuroStar). Time to remission studies of 247 case reports (N=98 males; N=149 females) showed consistently greater clinically defined remission rates after 6 weeks of rTMS treatment for patients using the MagVenture vs NeuroStar instrument. Patients previously admitted for inpatient psychiatric hospitalization exhibited higher response rates when treated with the MagVenture rTMS unit. Stepwise Cox Proportional Hazards Regression final model of time to remission included rTMS unit, inpatient psychiatric hospitalization and obese body habitus. Response to rTMS in applied clinical practice is related to severity of psychiatric illness and may require consideration of magnetic field parameters of the rTMS unit with respect to individual factors such as sex or body composition.
Highlights
We recently examined the effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) in combination with cognitive behavioral therapy (CBT) in the treatment of Major Depressive Disorder (MDD) using data derived from a retrospective review of medical records from patients with MDD undergoing rTMS therapy at a suburban tertiary psychiatric clinic, AwakeningsKC Clinical Neuroscience Institute (CNI).[16]
We examined data from the electronic medical records at AwakeningKC CNI for patients experiencing up to 6 weeks of rTMS therapy for MDD
This relationship appeared to be moderated by the rTMS unit utilized for treatment with greater remission rates observed among patients with a previ
Summary
Major Depressive Disorder (MDD) can be characterized by neurobiological abnormalities in regulatory feedback pathways involving select brain regions and neurotransmitter systems.[1,2] Repetitive Transcranial Magnetic Stimulation (rTMS) was developed to treat subjective symptoms of depression through the modulation of activity within orbital frontal corticostriatal (OFC) circuits involving the medial prefrontal cortex (mPFC), the hippocampus, the limbic system, amygdala, and other regions.[3,4,5] Transcranial Magnetic Stimulation has proven to be efficacious at alleviating depression symptoms over a wide range of settings for treatment-resistant cases of MDD.[6,7,8,9,10,11,12] The technology is widely utilized in clinical practice but the practical application to ethnically, financially, and geographically diverse patient groups with complex comorbidities require further characterization.[13,14,15]. Our investigation identified several unexpected factors that appeared to moderate clinical response, most notably, a proportionately greater clinical response was identified among patients treated using the MagVenture over the NeuroStar rTMS instrument. The present study extends the analysis of our midwestern cohort using Cox Proportional Hazards regression and Log-Rank statistics to investigate time to clinically rated remission from depression
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