Transcranial Magnetic Stimulation For Treatment-resistant Depression Research Articles

Effects of TMS on anhedonia and suicidal ideation in treatment-resistant depression: Outcomes from the University of Minnesota Interventional Psychiatry Program

BackgroundA developing literature suggests that transcranial magnetic stimulation (TMS) can target anhedonia and suicidal ideation (SI), core symptoms of treatment-resistant depression (TRD). This present naturalistic study extends the existing literature by investigating the connection between changes in anhedonia and suicidal ideation (SI) related to transcranial magnetic stimulation (TMS), independent of any overall changes in depression. MethodsPre and post treatment PHQ-9 and IDS-SR data were collected from 181 TRD patients who received dorsolateral prefrontal cortex ( dlPFC) TMS using the Figure-8 or H1-coil. Changes in overall depression symptoms, anhedonia, and SI were analyzed using chi square tests, repeated measure ANOVAS, and linear regression for repeated measures. ResultsTMS yielded changes in overall depression symptoms (PHQ-9 Cohen’s d = 1.02; IDS-SR Cohen’s d = 1.05), with 23.9 % and 41.7 % of patients experiencing response as measured by IDS-SR and PHQ-9, respectively. TMS treatment was also associated with large changes in both anhedonia (d = 1.03) and SI (d = 0.88), which were similar in magnitude to changes in all other depression symptoms (d = 0.97). Importantly, changes in anhedonia predicted changes in SI, even after controlling for baseline depression severity and change in other depression symptoms. LimitationsThe lack of a control arm and a neuroimaging measure temper mechanistic conclusion. ConclusionOur results reinforce the effectiveness of TMS in TRD and provide new evidence that anhedonia and SI may belong to a broader symptom cluster potentially undergirded by a shared circuitry accessible to dlPFC TMS.

Recent Advances in the Treatment of Treatment-Resistant Depression: A Narrative Review of Literature Published from 2018 to 2023.

We review recent advances in the treatment of treatment-resistant depression (TRD), a disorder with very limited treatment options until recently. We examine advances in psychotherapeutic, psychopharmacologic, and interventional psychiatry approaches to treatment of TRD. We also highlight various definitions of TRD in recent scientific literature. Recent evidence suggests some forms of psychotherapy can be effective as adjunctive treatments for TRD, but not as monotherapies alone. Little recent evidence supports the use of adjunctive non-antidepressant pharmacotherapies such as buprenorphine and antipsychotics for the treatment of TRD; side effects and increased medication discontinuation rates may outweigh the benefits of these adjunctive pharmacotherapies. Finally, a wealth of recent evidence supports the use of interventional approaches such as electroconvulsive therapy, ketamine/esketamine, and transcranial magnetic stimulation for TRD. Recent advances in our understanding of how to treat TRD have largely expanded our knowledge of best practices in, and efficacy of, interventional psychiatric approaches. Recent research has used a variety of TRD definitions for study inclusion criteria; research on TRD should adhere to inclusion criteria based on internationally defined guidelines for more meaningfully generalizable results.

Transcranial Magnetic Stimulation for Treatment-Resistant Depression: An Interactive Self-Learning Module.

The use of transcranial magnetic stimulation (TMS) has become increasingly prevalent in psychiatry. A growing body of literature supports its use with treatment-resistant depression (TRD), and this indication has gained FDA approval. However, new psychiatry residents often have little exposure to or understanding of TMS. This animated, fully narrated, self-learning module (SLM) introduces learners to TMS and its use in TRD and can be completed within 30 minutes. The goal is for viewers to be proficient with the basic science, indications, contraindications, side effects, and treatment process for TMS in TRD. Self-assessment questions throughout the module highlight and reinforce key learning points falling under the educational objectives. This SLM was deployed with PGY 1-4 training residents at the University of Minnesota during the 2016-2017 academic year as part of a study aimed at improving TMS education within our residency program. Fourteen residents participated in the study and offered feedback on the SLM's efficacy using 5-point Likert-scale surveys. Prior to the SLM's completion, the percentage of participants who disagreed or strongly disagreed with having met individual educational objectives ranged from 64% to 86%. Following completion, the percentage who agreed or strongly agreed with having met individual objectives ranged from 79% to 93%. This SLM provides an introductory curriculum on TMS for TRD to medical students and psychiatry residents who otherwise might not be adequately exposed to this treatment modality. As institutions adopt TMS, the module can serve as a primer for trainees prior to hands-on experience with the technology.

Emerging Areas of Transcranial Magnetic Stimulation use in Psychiatry

Transcranial magnetic stimulation (TMS) is most widely known clinically as a treatment for medication-refractory major depressive disorder, but it holds promise in a number of other areas. In addition to emerging neurologic areas of investigation such as in mild cognitive impairment, dementia, Parkinson's disease and stroke rehab, novel approaches to psychiatric conditions are also being explored. This review provides a critical condensation of the available data assessing the efficacy of TMS in the treatment of other psychiatric conditions, namely bipolar disorder, substance use, post-traumatic stress disorder and other anxiety disorders. Each section details the field's current accumulation of evidence of the respective condition's pathophysiology in the context of a discussion of the relevant therapeutic target(s) of TMS. Each section then reviews both positive and negative studies evaluating TMS in clinical practice. Given the relative tolerability and proven efficacy of TMS in treatment-resistant depression (TRD), further study to determine its therapeutic effect in other psychiatric entities is warranted.