Accelerated repetitive transcranial magnetic stimulation for treatment-resistant depression

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) has shown safety and efficacy for treatment-resistant depression, but requires daily treatment for 4-6 weeks. Accelerated TMS, with all treatments delivered over a few days, would have significant advantages in terms of access and patient acceptance.

Methods: Open-label accelerated TMS (aTMS), consisting of 15 rTMS sessions administered over 2 days, was tested in 14 depressed patients not responding to at least one antidepressant medication. Effects on depression, anxiety, and cognition were assessed the day following treatment, then after 3 and 6 weeks.

Results: No seizure activity was observed and only one patient had a serious adverse event (increased suicidal ideation). Two patients failed to complete a full course of aTMS treatments, and 36% did not complete all study visits. Depression and anxiety significantly decreased following aTMS treatments and improvements persisted 3 and 6 weeks later. Response rates immediately following treatment and at 3 and 6 weeks were 43, 36, and 36%, respectively. Remission rates at the same timepoints were 29, 36, and 29%.

Conclusions: Accelerated TMS demonstrated an excellent safety profile with efficacy comparable to that achieved in daily rTMS in other trials. Limitations primarily include open-label treatment and a small sample size.

Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

PEH has received grant funding from the Dana Foundation, Greenwall Foundation, NARSAD, National Institute of Mental Health (NIMH) (K23 MH077869), National Institutes of Health Loan Repayment Program, Northstar, Inc., Stanley Medical Research Institute, and Woodruff Foundation; he has received consulting fees from AvaCat Consulting, St. Jude Medical Neuromodulation and Oppenheimer & Co.

WMM has received grant funding from the NIMH (R01 MH069886: Optimization of TMS in the Treatment of Depression) which uses Neuronetics transcranial magnetic stimulators. Dr. McDonald works for Emory University which holds the patent for the magnetic stimulators gused in that trial. Dr. McDonald also receives grant funding from the National Institute of Neurological Disease and Stroke (R01 NS046487) for a trial that is evaluating antidepressant medication in PD donated by Smith Kline (Paxil CR) and Wyeth (Effexor XR).

CME has received patent royalties and consulting fees from Neuronetics, Inc. (Note that the present study did not receive any support from Neuronetics. Neuronetics did not contribute to the design of the study or data analyses, nor did the study use a Neuronetics device.) Dr. Epstein has received research support from GlaxoSmithKline, Inc. and UCB, Inc. for studies unrelated to depression.

No other authors report any conflicts of interest over the past 3 years.

Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc.

Figures

Figure

Measures were standardized (z-score) to show effect sizes on the same graph. HDRS24=24-item Hamilton Depression Rating Scale; HAM-A=Hamilton Rating Scale for Anxiety; BDI=Beck Depression Inventory; RBANS=Repeatable Battery for the Assessment of Neuropsychological Status (total score).