rTMS Treatment For Depression Research Articles

Beam F3 and 5.5 cm targeting show similar efficacy in rTMS treatment of depression: a randomized trial

Beam F3 and 5.5 cm targeting show similar efficacy in rTMS treatment of depression: a randomized trial

Holding Steady: Age-Related Effects on Treatment Response During rTMS Treatment of Depression

Holding Steady: Age-Related Effects on Treatment Response During rTMS Treatment of Depression

Agreeing to disagree: inter-subject variability of mood rating scales during rtms treatment of depression

Agreeing to disagree: inter-subject variability of mood rating scales during rtms treatment of depression

Clinical Practice Guidelines for the Therapeutic Use of Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders.

Clinical Practice Guidelines for the Therapeutic Use of Repetitive Transcranial Magnetic Stimulation in Neuropsychiatric Disorders.

PO080 / #705 NOVEL MULTI-TARGET REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION PROTOCOL FOR THE TREATMENT OF COMORBID DEPRESSION AND CHRONIC PAIN: E-POSTER VIEWING

Major Depressive Disorder (MDD) and chronic pain are frequently co-occurring, and the onset of either condition can either precede or follow the onset of the other. Notably, clinical outcome for pharmacological and rTMS treatment for depression is significantly worse in the presence of chronic pain symptoms. To improve clinical care for depression it is thus critical to address the comorbidity of depression and chronic pain in a unified approach rather than treating them as separate conditions. We examined whether an open label multi-target rTMS protocol including stimulation of the left dorsolateral prefrontal cortex (DLPFC) and primary motor cortex (M1), the most effective rTMS target for pain, would improve depressive and chronic pain symptoms more than a single target DLPFC stimulation.

RTMS Therapy Reduces Hypofrontality in Patients With Depression as Measured by fNIRS.

Multichannel functional near-infrared spectroscopy (fNIRS) is a tool used to capture changes in cerebral blood flow. A consistent result for depression is a decrease in blood flow in the frontal cortex leading to hypofrontality, which indicates multidomain functional impairment. Repetitive transcranial magnetic stimulation (rTMS) and elective convulsive therapy (ECT) are alternatives to antidepressant drugs for the treatment of depression but the underlying mechanism is yet to be elucidated. The aim of the current study was to evaluate cerebral blood flow using fNIRS following rTMS treatment in patients with depression. The cerebral blood flow of 15 patients with moderate depression after rTMS treatment was measured using fNIRS. While there was clear hypofrontality during pre-treatment (5 ± 2.5), a notable increase in oxygenated hemoglobin was observed after 30 sessions with rTMS (50 ± 15). This increased blood flow was observed in a wide range of channels in the frontal cortex; however, the centroid values were similar between the treatments. Increased blood flow leads to the activation of neuronal synapses, as noted with other neuromodulation treatments such as electroconvulsive therapy. This study describes the rTMS-induced modulation of blood oxygenation response over the prefrontal cortex in patients with depression, as captured by fNIRS. Future longitudinal studies are needed to assess cerebral blood flow dynamics during rTMS treatment for depression.

Book Review: rTMS treatment for depression. A practical guide

Book Review: rTMS treatment for depression. A practical guide

Multi-target repetitive transcranial magnetic stimulation (rTMS) protocol for the treatment of comorbid depression and chronic pain

Abstract Background: Major Depressive Disorder (MDD) and chronic pain are frequently co-occurring, and the onset of either condition can either precede or follow the onset of the other. Notably, clinical outcome for pharmacological and rTMS treatment for depression is significantly worse in the presence of chronic pain symptoms. To improve clinical care for depression it is thus critical to address the comorbidity of depression and chronic pain in a unified approach rather than treating them as separate conditions. Objective: We examined whether a multi-target rTMS protocol including stimulation of the left dorsolateral prefrontal cortex (DLPFC) and primary motor cortex (M1) would improve depressive and chronic pain symptoms more than a standard single-target rTMS protocol. Methods: We treated 20 comorbid depressive and chronic pain patients with a multi-target rTMS protocol and another 20 age- and sex-matched comorbid patients that had comparable baseline depression and pain symptom severity were treated only at the left DLPFC, for a minimum of 10 sessions. We have also recorded electroencephalography (EEG) at baseline session and examined a previously reported metric of pain sensitivity, peak alpha frequency (PAF), as a possible marker of treatment outcome. Preliminary Results: The multi-target rTMS achieved on average 15% greater improvement than stimulation at left DLPFC alone. Cohen’s D effect size was D = 0.8, which represents a moderate effect. We will also present EEG data examining the associations between PAF and pain and depression treatment outcomes. Conclusions: Multi-target rTMS to DLPFC and M1 may be more effective in treating the comorbidity of depression and chronic pain than rTMS to DLPFC only. Multi-site protocols could represent a treatment augmentation strategy with significant benefit for comorbid subjects. Other potential rTMS target site should be evaluated in future studies. Keywords: Chronic Pain, Depression, EEG, TMS

Repetitive Transcranial Magnetic Stimulation: Influence on Stress and Early Responsiveness Outcomes for Depression, Anxiety, and Stress

The present study investigated whether rTMS treatment for depression reduced stress and whether early responsiveness of rTMS predicted outcomes for depression, anxiety, and stress at the conclusion of treatment. Participants (n = 109)were inpatients at a psychiatric hospital referred for rTMS for depression. Linear mixed models were used to analyse data across time and regression analyses were used to assess early responsiveness. Effect sizes, and clinically significant and reliable change were also analysed. Decreases in scores for depression, anxiety, and stress were evident from pre- to mid-treatment, and from mid- to post-treatment. Large effect sizes were reported from pre- to post-treatment for depression and stress. Changes in depression from pre- to mid-treatment predicted post-treatment depression and stress scores. Clinically significant change was most common for stress and reliable change was most common for depression. Standard rTMS treatment for depression appears to have non-specific benefits in that participant anxiety and stress ratings also improve significantly. Early improvements in depressive symptoms may be indicative of later depression and stress outcomes, suggesting clinical benefit in assessing outcomes during rTMS treatment.

Day-to-day variability in motor threshold during rTMS treatment for depression: Clinical implications

BackgroundWhen repetitive transcranial magnetic stimulation (rTMS) is used to treat medication refractory depression, the treatment pulse intensity is individualized according to motor threshold (MT). This measure is often acquired only on the first day of treatment, as per the protocol currently approved by Food and Drug Administration. ObjectiveHere, we aimed to assess daily MT variability across an rTMS treatment course and simulate the effects of different schedules of MT assessment on treatment intensity. MethodsWe conducted a naturalistic retrospective study with 374 patients from a therapeutic rTMS program for depression that measures MT daily. ResultsFor each patient, in almost half the TMS sessions, MT varied on average more than 5% as compared to the baseline MT acquired in the first treatment day. Such variability was only minimally impacted by having different TMS technicians acquiring MT in different days. In a smaller cohort of healthy individuals, we confirmed that the motor hotspot localization method, a critical step for accurate MT assessment, was stable in different days, arguing that daily MT variability reflects physiological variability, rather than an artifact of measurement error. Finally, in simulations of the effect of one-time MT measurement, we found that half of sessions would have been 5% or more above or below target intensity, with almost 5% of sessions 25% above target intensity. The simulated effects of weekly MT measurements were significantly improved. ConclusionsIn conclusion, MT varies significantly across days, not fully dependent on methods of MT acquisition. This finding may have important implications for therapeutic rTMS practice regarding safety and suggests that regular MT assessments, daily or at least weekly, would ameliorate the effect.

A bibliometric analysis of top 50-most cited articles on repetitive trans-cranial magnetic stimulation (rTMS) for treatment of depression

BackgroundCitation count can be used as a key tool to assess the quality of the published literature and because of its immense advantages it is now widely used in ranking the articles on specific topics. Objective/hypothesisTo extract and assess the top cited work on repetitive transcranial magnetic stimulation (rTMS) for depression treatment. MethodsScopus Library Database was searched and two independent authors produced a list of 50 most cited articles on repetitive transcranial magnetic stimulation (rTMS) for treatment of depression. All the relevant articles having key-terms within their titles, abstract and keywords were included in our search. Our list was categorized into two categories, “mixed” and “focused”. ResultsThe articles in the produced list of top 50 most cited articles on rTMS for treatment of depression belong to the time period 1993–2012 with total citation count 12078. George MS was prominent in the list. ‘Biological Psychiatry’ published most number of articles (n = 13) among the list. Articles were categorized on the basis of primary population and intervention into ‘Focused’ and ‘Mixed’ categories. LimitationsArticles that were published before 1993 and after 2012 on rTMS for depression couldn't made it to the final list of top-50 most cited article. ConclusionWe attempted to conduct a topic-specific citation analysis considering the paucity of specified bibliometrics in medical literature. Our research provides an insight on emerging trends in rTMS for depression and highlights the characteristics, quality and dynamics of frequently cited articles in the field.

EL-2 Current situation of rTMS treatment for depression in Japan

EL-2 Current situation of rTMS treatment for depression in Japan

Side effects trajectories in rTMS treatment for depression: 10 Hz vs. intermittent theta-burst stimulation

Side effects trajectories in rTMS treatment for depression: 10 Hz vs. intermittent theta-burst stimulation

P273 Effect of repetitive transcranial magnetic stimulation on the structural connectome in patients with major depression

Introduction Repetitive transcranial magnetic stimulation (rTMS) of the dorsolateral prefrontal cortex (DLPFC) is an FDA-approved treatment for depression. Increasing evidence indicates that depression is accompanied by altered structural connectivity in the white matter. Objective We assess the impact of rTMS treatment for depression on the structural brain connectome. Patients and methods The IRB of Weill Cornell Medical College approved this study. 25 currently treatment-resistant depressed patients (age 21–68) participated in the study. Patients received 10-Hz rTMS over the left DLPFC 5 days/week for 5 weeks. Treatment response was assessed using the 24-item Hamilton Rating Scale for Depression (HAMD-24) at baseline and after the course of TMS. MRIs were acquired within 7 days prior to starting rTMS and within 3 days after the end of treatment. Diffusion tensor images were acquired using a single-shot spin echo imaging sequence. Nodes of the structural brain network were defined as the 96 anatomical brain areas in the Harvard-Oxford atlas. Whole brain deterministic streamline generation was performed using the Euler delta crossings tracking algorithm. A weighted connectivity matrix was generated based on the number of streamlines traversing between pairwise cortical regions. Graph theory metrics were calculated to assess network integration (characteristic path length), distribution (network density), segregation (clustering coefficient, modularity), and nodal influence (nodal degree, betweenness centrality). Results Relative to baseline, no change was observed post rTMS in the global network metrics of density, characteristic path length, and modularity. No group difference was observed between treatment responders and nonresponders on these global network metrics. Fig. 1 shows the distribution of nodes with properties that correlate (p Conclusion A collection of nodes in the frontal pole, frontal medial cortex, subcallosal cingulate, and lateral occipital cortex (LOC) have baseline nodal degree, centrality, and clustering coefficient that are correlated with baseline HAMD-24. The post treatment change in centrality in the LOC and precuneus is correlated with change in HAMD-24, suggesting rTMS selectively modulates the white matter connectivity underlying key areas in the default mode network. Download : Download high-res image (888KB) Download : Download full-size image

Advancing rTMS treatment of depression

Advancing rTMS treatment of depression

Interest of targeting either cortical area Brodmann 9 or 46 in rTMS treatment for depression: A preliminary randomized study

ObjectiveTo assess the interest of specifically targeting Brodmann Areas (BA) 9 or 46 for rTMS treatment of depression. MethodsPatients with Treatment-Resistant Depression were randomly assigned to two treatment groups to receive either rTMS on BA 9 or on BA 46. Each patient underwent 10 sessions of 1Hz-rTMS for 2weeks. The Hamilton and Montgomery–Asberg Depression Rating Scales (HDRS, MADRS) were used under blind conditions to assess the therapeutic response (50% improvement). A Wilcoxon signed-rank test was used to compare the depression rating scales scores obtained before and after the 10 rTMS sessions for each of the two groups. The therapeutic results in the two groups were compared using the Mann–Whitney–Wilcoxon test. We also reported the effect sizes using Hedges’s g. ResultsFifteen patients were included. Stimulation of both BA 9 (n=7) and BA 46 (n=8) led to similar therapeutic responses in the two groups (with moderate effect size), such as the mean decrease in HDRS (BA 9: p=0.015; BA 46: p=0.010) and MADRS (BA 9: p=0.042; BA 46: p=0.038) scores. ConclusionOur results do not come out in favor of one or the other BA. SignificanceStimulation of BA 9 and BA 46 appears to be equally effective in the treatment of depression.

RTMS for Treatment of Depression in a Patient With Cerebral Amyloid Angiopathy: A Case Report on Safety and Efficacy

rTMS for Treatment of Depression in a Patient With Cerebral Amyloid Angiopathy: A Case Report on Safety and Efficacy

P02-251 - Low frequency repetitive transcranial magnetic stimulation in elderly: Effects on mood and cognitive functions

Increasing the options for effective treatment of depression in elderly with the aim of improving quality of life remains a critical public health goal. Late-life depression is associated with cognitive impairment and dementia. Pharmacological therapy is a common modality of treatment for depression during the late-life period. Antidepressants seem to have some efficacy in improving cognitive functions. However pharmacological treatment in elderly causes some trouble because of the risk of metabolic side effects. Continuing use of antidepressant medication is associated with an increased relative risk of type 2 diabetes.Repetitive Transcranial Magnetic Stimulation (rTMS) represents an effective, well-tolerated non-pharmacological treatment for depression. Recently rTMS has been proposed as a possible treatment for the cognitive deficits associated with Alzheimer disease (AD). The findings of a recent study provide initial evidence for the persistent beneficial effects of rTMS on sentence comprehension in AD patients.We propose the use of rTMS for treatment of depression in elderly in order to reduce the risk of metabolic side effects and to improve cognitive functions. In our experience, elderly depressed patient treated with rTMS, at 1 Hz at 110% of Rest Motor Threshold (RMT) over the right Dorso-Lateral Pre-Frontal Cortex (DLPFC) for three or four weeks, show a significant reduction in depressive symptomatology and furthermore a significant improving in cognitive functions (verbal fluency, visual-spatial memory and score in the MINI-Mental State Examination).

Stimulus intensity dependence of cerebral blood volume changes in left frontal lobe by low-frequency rTMS to right frontal lobe: A near-infrared spectroscopy study

Repetitive transcranial magnetic stimulation (rTMS) has recently been widely employed for the investigation of brain function and treatment of psychiatric and neurological disorders. Although high and low stimulation frequencies are assumed to activate and deactivate brain function, respectively, the optimal parameters of rTMS for treatment of depression have been determined only on the basis of their clinical efficacy. In this study, we administered a 60-s low-frequency rTMS of three grades low intensities over the right dorsolateral prefrontal cortex (DLPFC) in 10 healthy volunteers, and monitored functional changes of the contralateral DLPFC by near-infrared spectroscopy (NIRS) during and immediately after rTMS. Obtained results demonstrated significant [oxy-Hb] decreases during rTMS, and significant differences in the time courses of [oxy-Hb] changes among three stimulus intensities, that is, [oxy-Hb] decreases were most prominent during the latter half of the stimulation and the first 30 s of poststimulation only at 15 mm condition (58% intensity). These results suggest that monitoring of brain functional changes due to rTMS using NIRS is useful for elucidating the brain mechanisms underlying the clinical effects of rTMS, and the effects of rTMS over contralateral DLPFC are obtained if the stimulus intensities are more than one-half of the motor thresholds.

RTMS treatment of depression – results under naturalistic conditions

Repetitive transcranial magnetic stimulation (rTMS) is increasingly used in clinical practice, especially for the treatment of drug-resistant depressive syndromes. A large number of controlled studies strongly suggest antidepressant efficacy of rTMS. However systematic observations of optimal stimulation parameters and clinical relevance under naturalistic conditions are still lacking.