Intensive HF-rTMS treatment in refractory medication-resistant unipolar depressed patients

Chris Baeken; Marie-Anne Vanderhasselt; Jonathan Remue; Sarah Herremans; Nathalie Vanderbruggen; Dieter Zeeuws; Liesbeth Santermans; Rudi De Raedt

doi:10.1016/j.jad.2013.07.008

Intensive HF-rTMS treatment in refractory medication-resistant unipolar depressed patients

J Affect Disord. 2013 Nov;151(2):625-631. doi: 10.1016/j.jad.2013.07.008. Epub 2013 Jul 26.

Authors

Chris Baeken¹, Marie-Anne Vanderhasselt², Jonathan Remue², Sarah Herremans³, Nathalie Vanderbruggen³, Dieter Zeeuws³, Liesbeth Santermans³, Rudi De Raedt²

Affiliations

¹ Department of Psychiatry and Medical Psychology, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium; University Hospital (UZBrussel), Department of Psychiatry, Brussels, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium. Electronic address: cbaeken@hotmail.com.
² Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium.
³ University Hospital (UZBrussel), Department of Psychiatry, Brussels, Belgium.

PMID: 23896317
DOI: 10.1016/j.jad.2013.07.008

Abstract

Background: Major depression is a worldwide severe mental health problem. Unfortunately, not all depressed patients respond to pharmacotherapy or psychotherapy, even when adhering to treatment guidelines. Even though current guidelines do not in particular advocate repetitive Transcranial Magnetic Stimulation (rTMS) in refractory treatment resistant depression (TRD), using more intensive stimulation parameters might hold promise as a valuable alternative.

Objective: Consequently, in this randomized sham-controlled crossover study, we wanted to evaluate clinical outcome of intensive HF-rTMS treatment in TRD when applied to the left dorsolateral prefrontal cortex (DLPFC).

Methods: After a 2-week antidepressant washout, 20 unipolar TRD patients, at least stage III, received 20 sham-controlled high-frequency (HF)-rTMS sessions, in a crossover design. Five daily suprathreshold HF-rTMS sessions were spread over four successive days delivering in total 31,200 stimuli.

Results: Overall, the procedure resulted in immediate statistical significant decreases in depressive symptoms regardless of order/type of stimulation (real/sham), suggesting possible placebo responses. On the other hand, albeit only 35% (7/20) of the patients showed a 50% reduction of their initial Hamilton Depression rating score at the end of the two-week procedure, all these patients showed a prompt clinical response after real HF-rTMS treatment, not after sham. Furthermore, a shorter duration of the current depressive episode was a predictor for beneficial clinical outcome. Unresponsiveness to former ECT could be indicative for negative clinical outcome in these kinds of patients.

Limitations: Single center setup with relatively small sample size and no follow-up.

Conclusions: Our findings indicate that intensive HF-rTMS treatment might have the potential to result in fast clinical response when confronted with a refractory TRD patient.

Keywords: HF-rTMS; Intensive; Left DLPFC; Medication-resistance; Refractory major depression.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Over Studies
Depressive Disorder, Treatment-Resistant / therapy*
Female
Humans
Male
Middle Aged
Prefrontal Cortex
Transcranial Magnetic Stimulation*
Treatment Outcome