Repetitive Transcranial Magnetic Stimulation in Youth With Treatment Resistant Major Depression

Frank P MacMaster, Paul E Croarkin, T Christopher Wilkes, Quinn McLellan, Lisa Marie Langevin, Natalia Jaworska, Rose M Swansburg, Yamile Jasaui, Ephrem Zewdie, Patrick Ciechanski, Adam Kirton, Frank P MacMaster, Paul E Croarkin, T Christopher Wilkes, Quinn McLellan, Lisa Marie Langevin, Natalia Jaworska, Rose M Swansburg, Yamile Jasaui, Ephrem Zewdie, Patrick Ciechanski, Adam Kirton

Abstract

Background: Major depressive disorder (MDD) is common in youth and treatment options are limited. We evaluated the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) in adolescents and transitional aged youth with treatment resistant MDD. Methods: Thirty-two outpatients with moderate to severe, treatment-resistant MDD, aged 13-21 years underwent a three-week, open-label, single center trial of rTMS (ClinicalTrials.gov identifier NCT01731678). rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) using neuronavigation and administered for 15 consecutive week days (120% rest motor threshold; 40 pulses over 4 s [10 Hz]; inter-train interval, 26 s; 75 trains; 3,000 pulses). The primary outcome measure was change in the Hamilton Depression Rating Scale (Ham-D). Treatment response was defined as a >50% reduction in Ham-D scores. Safety and tolerability were also examined. Results: rTMS was effective in reducing MDD symptom severity (t = 8.94, df = 31, p < 0.00001). We observed 18 (56%) responders (≥ 50% reduction in Ham-D score) and 14 non-responders to rTMS. Fourteen subjects (44%) achieved remission (Ham-D score ≤ 7 post-rTMS). There were no serious adverse events (i.e., seizures). Mild to moderate, self-limiting headaches (19%) and mild neck pain (16%) were reported. Participants ranked rTMS as highly tolerable. The retention rate was 91% and compliance rate (completing all study events) was 99%. Conclusions: Our single center, open trial suggests that rTMS is a safe and effective treatment for youth with treatment resistant MDD. Larger randomized controlled trials are needed. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01731678.

Keywords: adolescent; brain stimulation; depression; dorsolateral prefrontal cortex (DLPFC); transcrancial magnetic stimulation (TMS).

Figures

Figure 1
Figure 1
Basic study design. rTMS, repetitive transcranial magnetic stimulation; RMT, resting motor threshold.
Figure 2
Figure 2
Summary of clinical outcomes. rTMS, repetitive transcranial magnetic stimulation.

References

    1. Carvalho AF, Cavalcante JL, Castelo MS, Lima MC. Augmentation strategies for treatment-resistant depression: a literature review. J Clin Pharm Ther. (2007) 32:415–28. 10.1111/j.1365-2710.2007.00846.x
    1. Adegbite-Adeniyi C, Gron B, Rowles BM, Demeter CA, Findling RL. An update on antidepressant use and suicidality in pediatric depression. Expert Opin Pharmacother. (2012) 13:2119–30. 10.1517/14656566.2012.726613
    1. Menke A, Domschke K, Czamara D, Klengel T, Hennings J, Lucae S, et al. . Genome-wide association study of antidepressant treatment-emergent suicidal ideation. Neuropsychopharmacology. (2012) 37:797–807. 10.1038/npp.2011.257
    1. Cipriani A, Zhou X, Del Giovane C, Hetrick SE, Qin B, Whittington C, et al. . Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet. (2016) 388:881–90. 10.1016/S0140-6736(16)30385-3
    1. Fava M. Diagnosis and definition of treatment-resistant depression. Biol Psychiatry. (2003) 53:649–59. 10.1016/S0006-3223(03)00231-2
    1. Souery D, Serretti A, Calati R, Oswald P, Massat I, Konstantinidis A, et al. Switching antidepressant class does not improve response or remission in treatment-resistant depression. J Clin Psychopharmacol. (2011) 31:512–6. 10.1097/JCP.0b013e3182228619
    1. MacMaster FP, Sembo M, Ma K, Croarkin P. Brain stimulation in childhood mental health: Therapeutic applications. In: Pediatric Brain Stimulation: Mapping and Modulating the Developing Brain 1 ed, editors. Kirton A., Gilbert DL, Toronto, ON: Elsevier; (2016).
    1. George MS. Transcranial magnetic stimulation for the treatment of depression. Expert Rev Neurother. (2010) 10:1761–72. 10.1586/ern.10.95
    1. Lefaucheur JP, Andre-Obadia N, Antal A, Ayache SS, Baeken C, Benninger DH, et al. . Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol. (2014) 125:2150–206. 10.1016/j.clinph.2014.05.021
    1. Leggett LE, Soril LJJ, Coward S, Lorenzetti DL, MacKean G, Clement FM. Repetitive transcranial magnetic stimulation for treatment-resistant depression in adult and youth populations: a systematic literature review and meta-analysis. Primary Care Comp CNS Disord. (2015) 17. 10.4088/PCC.15r01807
    1. Milev RV, Giacobbe P, Kennedy SH, Blumberger DM, Daskalakis ZJ, Downar J, et al. . Canadian network for mood and anxiety treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: Section 4. Neurostimulation treatments. Can J Psychiatry. (2016) 61:561–75. 10.1177/0706743716660033
    1. McClintock SM, Reti IM, Carpenter LL, McDonald WM, Dubin M, Taylor SF, et al. . Consensus recommendations for the clinical application of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. J Clin Psychiatry. (2017) 79:16cs10905. 10.4088/JCP.16cs10905
    1. Donaldson AE, Gordon MS, Melvin GA, Barton DA, Fitzgerald PB. Addressing the needs of adolescents with treatment resistant depressive disorders: a systematic review of rTMS. Brain Stimul. (2014) 7:7–12. 10.1016/j.brs.2013.09.012
    1. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. . Schedule for affective disorders and schizophrenia for school-Age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. (1997) 36:980–8. 10.1097/00004583-199707000-00021
    1. Poznanski E, Freeman LN, Mokros HB. Children's depression rating scale-revised. Psychopharmacol Rev. (1985) 21:979–89.
    1. Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. (1967) 6:278–96. 10.1111/j.2044-8260.1967.tb00530.x
    1. Beck AT, Guth D, Steer RA, Ball R. Screening for major depression disorders in medical inpatients with the beck depression inventory for primary care. Behav Res Ther. (1997) 35:785–91. 10.1016/S0005-7967(97)00025-9
    1. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. (1959) 32:50–5. 10.1111/j.2044-8341.1959.tb00467.x
    1. Rush AJ, Kraemer HC, Sackeim HA, Fava M, Trivedi MH, Frank E, et al. . Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology. (2006) 31:1841–53. 10.1038/sj.npp.1301131
    1. Kirton A, Deveber G, Gunraj C, Chen R. Cortical excitability and interhemispheric inhibition after subcortical pediatric stroke: plastic organization and effects of rTMS. Clin Neurophysiol. (2010) 121:1922–9. 10.1016/j.clinph.2010.04.021
    1. George MS, Wassermann EM, Williams WA, Callahan A, Ketter TA, Basser P, et al. . Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport. (1995) 6:1853–6. 10.1097/00001756-199510020-00008
    1. George MS, Wassermann EM, Williams WA, Steppel J, Pascual-Leone A, Basser P, et al. . Changes in mood and hormone levels after rapid-rate transcranial magnetic stimulation (rTMS) of the prefrontal cortex. J Neuropsychiatry Clin Neurosci. (1996) 8:172–80. 10.1176/jnp.8.2.172
    1. Herwig U, Padberg F, Unger J, Spitzer M, Schonfeldt-Lecuona C. Transcranial magnetic stimulation in therapy studies: examination of the reliability of “standard” coil positioning by neuronavigation. Biol Psychiatry. (2001) 50:58–61. 10.1016/S0006-3223(01)01153-2
    1. Herwig U, Satrapi P, Schonfeldt-Lecuona C. Using the international 10-20 EEG system for positioning of transcranial magnetic stimulation. Brain Topogr. (2003) 16:95–9. 10.1023/B:BRAT.0000006333.93597.9d
    1. Kirton A, Chen R, Friefeld S, Gunraj C, Pontigon AM, Deveber G. Contralesional repetitive transcranial magnetic stimulation for chronic hemiparesis in subcortical paediatric stroke: a randomised trial. Lancet Neurol. (2008) 7:507–13. 10.1016/S1474-4422(08)70096-6
    1. Davis NJ. Transcranial stimulation of the developing brain: a plea for extreme caution. Front Hum Neurosci. (2014) 8:600. 10.3389/fnhum.2014.00600
    1. Garvey M. Transcranial magnetic stimulation studies in children. In: Magnetic Stimulation in Clinical Neurophysiology, editors. Hallet M, Chokroverty S. Philadelphia, PA: Elsevier; (2005). p. 429–33. 10.1016/B978-0-7506-7373-0.50033-X
    1. Benjamin DJ, Berger J, Johannesson M, Nosek BA, Wagenmakers EJ, Berk R, et al. Redefine Statistical Significance. (2017). Retrieved from:
    1. Kohut E. (2008). Chronic daily headache in children attending a tertiary referral headache clinic. In: VII International Conference on Headache in Children and Adolescents. Istanbul: Wiley.

Source: PubMed

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