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

• 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
• Journal Title: Depression and Anxiety
• Volume: Volume 29, Number 10
• Publisher: Wiley: 12 months | 2012-10-01, Pages 883-890
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/da.21967
• Subjects: Biology, Neuroscience; Psychology, Behavioral
• Keywords: Social Sciences; Science & Technology; Life Sciences & Biomedicine; Psychology, Clinical; Psychiatry; Psychology; transcranial magnetic stimulation; efficacy; follow-up; treatment-resistant; depression; MAJOR DEPRESSION; OPEN-LABEL; ELECTROCONVULSIVE-THERAPY; ANTIDEPRESSANT EFFICACY; RELAPSE; METAANALYSIS; MULTISITE; TRIAL; RTMS; PHARMACOTHERAPY

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.