LONG-TERM EFFICACY OF REPEATED DAILY PREFRONTAL TRANSCRANIAL MAGNETIC STIMULATION (TMS) IN TREATMNT-RESISTANT DEPRESSION

• Type of Material: Article
• Authors: Antonio Mantovani, Columbia University; Martina Pavlicova, Columbia University; David Avery, University of Washington; Ziad Nahas, American University of Beirut; William M. McDonald, Emory University; Chandra D. Wajdik, University of Washington; Paul Holtzheimer, Emory University; Mark S. George, Medical University of South Carolina; Harold A. Sackeim, Columbia University; Sarah H. Lisanby, Duke University
• Language: English
• Date: 2012-10-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/da.21967
• Title of Journal or Parent Work: Depression and Anxiety
• ISSN: 1091-4269
• Volume: 29
• Issue: 10
• Start Page: 883
• End Page: 890
• Grant/Funding Information: This study was supported by the National Institute of Mental Health funded Optimization of TMS for the Treatment of Depression Study (OPT-TMS) study involving grants 5R01MH069929 (Dr. Avery), 5R01MH069887 (Dr. George), 5R01MH069896 (Dr. George), 5R01MH069895 (Dr. Lisanby), and 5R01MH069886 (Dr. McDonald).; Following a competitive bid and request involving all TMS manufacturers at the time of trial initiation, Neuronetics Inc. was selected and loaned the TMS devices, head holders, and coils for the trial and allowed use of the safety Investigational Device Exemption for their device.
• Keywords: Life Sciences & Biomedicine; METAANALYSIS; TRIAL; follow-up; efficacy; Psychiatry; depression; ANTIDEPRESSANT EFFICACY; Science & Technology; Psychology; treatment-resistant; OPEN-LABEL; RELAPSE; ELECTROCONVULSIVE-THERAPY; RTMS; PHARMACOTHERAPY; MAJOR DEPRESSION; MULTISITE; Psychology, Clinical; Social Sciences; transcranial magnetic stimulation
• Research Categories: Psychology, Behavioral; Biology, Neuroscience

Abstract

Background A few studies have examined the durability of transcranial magnetic stimulation (TMS) antidepressant benefit once patients remitted. This study examined the long-term durability of clinical benefit from TMS using a protocol-specified TMS taper and either continuation pharmacotherapy or naturalistic follow-up. Methods Patients were remitters from an acute double-blind sham-controlled trial of TMS (n = 18), or from an open-label extension in patients who did not respond to the acute trial (n = 43). Long-term durability of TMS acute effect was examined in remitters over a 12-week follow-up. Relapse, defined as 24-item Hamilton Depression Rating Scale (HDRS-24) ≥20, was the primary outcome. Results Of 61 remitters in the acute trial, five entered naturalistic follow-up and 50 entered the TMS taper. Thirty-two patients completed TMS taper and 1-, 2-, and 3-month follow-up. At 3-month visit, 29 of 50 (58%) were classified as in remission (HDRS-24 ≤10), two of 50 (4%) as partial responders (30%a;circ HDRS-24 reduction < 50% from baseline), and one of 50 (2%) met criteria for relapse. During the entire 3-month follow-up, five of the 37 patients relapsed (relapse rate = 13.5%), but four of them regained remission by the end of the study. The average time to relapse in these five patients was 7.2 ± 3.3 weeks. Patients who relapsed had higher depression scores at 1 month. Conclusions While one third of the sample was lost to follow-up, our results demonstrate that most patients contributing to observations experienced persistence of benefit from TMS followed by pharmacotherapy or no medication. Longer follow-up and more rigorous studies are needed to explore the true long-term durability of remission produced by TMS.