Monday, January 30, 2023

Study Supports Repetitive TMS for Patients With Treatment-Resistant Depression

About 1 in 4 people with treatment-resistant depression may achieve remission with repetitive transcranial magnetic stimulation (rTMS), according to data collected from patients at five hospitals in France. The analysis, which was published in the Journal of Affective Disorders, also showed that patients with more severe symptoms at baseline experienced greater improvements following rTMS on average.

“To the best of our knowledge, this is the largest naturalistic study [of rTMS] with clinician-rated scales by … psychiatrists,” wrote Noomane Bouaziz, M.D., of EPS Ville Evrard in Neuilly-sur-Marne, France, and colleagues. “Our study encompasses a large variety of stimulation settings and comorbidities, reflecting usual clinical practice. Thus, this study is intended to guide psychiatrists in real-life practice, as a complement to [randomized, controlled trials] with strict inclusion criteria.”

Bouaziz and colleagues collected data from 435 adults who were treated with rTMS at one of five French University Hospitals between January 2015 and December 2020. The patients had a diagnosis of either unipolar or bipolar depression and had not responded to at least two trials of antidepressants. Many of these patients had psychiatric or other medical comorbidities; the only patients excluded from the study were those who had metallic implants, had nonstabilized epilepsy, and/or were pregnant. The rTMS protocols at the hospitals varied; the number of sessions ranged from 10 to 28 and the total delivered pulses per session ranged from 360 to 2,000.

The researchers compared patients’ Montgomery–├ůsberg Depression Rating Scale (MADRS) scores at baseline with those following the completion of rTMS. Overall, MADRS scores decreased by about 9.5 points, which represented a 33% reduction from baseline levels. In addition, 22.8% of the patients achieved remission (defined as a MADRS score of 10 or less).

Bouaziz and colleagues next looked at factors that might influence a patient’s response to rTMS. They found that patients with more severe baseline depression had greater MADRS improvements following rTMS on average, whereas patients with milder depression were more likely to achieve remission. Patients who did not have psychiatric comorbidities and those who were not taking lithium showed greater symptom improvement than those who did meet these criteria; however, neither the presence of comorbidities nor use of lithium impacted remission rate.

To read more on this topic, see the Psychiatric News article “TMS Should Be Considered as First-Line Treatment for Moderate to Severe Major Depressive Disorder.”

(Image: iStock/Henrik5000)




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