TMS FOR DEPRESSION

Long-Term Efficacy of Repeated Daily Prefrontal Transcranial Magnetic Stimulation (TMS) in Treatment-Resistant Depression. Depress Anxiety. 2012 October ; 29(10): 883–890

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.

Effectiveness of transcranial magnetic stimulation in clinical practice post-FDA approval in the United States: results observed with the first 100 consecutive cases of depression at an academic medical center. J Clin Psychiatry. 2012; 73: e567–73

Transcranial magnetic stimulation (TMS) is a US Food and Drug Administration–approved treatment for major depressive disorder (MDD) in patients who have not responded to 1 adequate antidepressant trial in the current episode. In a retrospective cohort study, we examined the effectiveness and safety of TMS in the first 100 consecutive patients treated for depression (full DSM-IV criteria for major depressive episode in either major depressive disorder or bipolar disorder) at an academic medical center between July 21, 2008, and March 25, 2011.

H-Coil Repetitive Transcranial Magnetic Stimulation for Treatment Resistant Major Depressive Disorder

Evidence has shown that repetitive transcranial magnetic stimulation (rTMS) can be effective as an acute treatment for major depressive disorder (MDD). However, few studies have examined the safety and feasibility of rTMS as a long-term\continuation treatment. Deep-TMS is a novel tool enabling deeper stimulation than standard coils. The current study examined the safety and feasibility of repetitive deep-TMS continuation treatment for MDD over the course of 18 weeks, following 4 weeks of acute treatment. A total of 29 MDD patients were enrolled in the study. rTMS sessions (20 Hz) were given for a total of 22 weeks, divided into: 4 weeks of acute daily treatments, followed by 18 weeks of continuation treatments. Clinical evaluations were performed weekly throughout the study. A significant decrease from baseline in Hamilton Depression Rating Scale (HDRS) score was found at the end of the acute phase, and maintained throughout the study ( P < 0.0001). The Kaplan – Meier estimated probability of response was 46.15% (SE = 9.78%) at the end of the acute phase, and 81.12% (SE = 9.32%) at the end of the study (22 weeks). Probability of remission at the end of the acute phase was 26.92% (SE = 8.70%) and 71.45% (SE = 10.99%) at the end of the study. Response in the acute phase was indicative of response in the continuation phases. The procedure was generally well tolerated and no adverse events were reported. The results suggest that H-coil deep-TMS administered continuation treatment can help maintain an antidepressant effect for 18 weeks, following 4 weeks of acute treatment.

Transcranial Magnetic Stimulation for Major Depressive Disorder: A Pragmatic Approach to Implementing TMS in a Clinical Practice. Ann Clin Psychiatry. 2010 Nov;22(4 Suppl):S4-11.

Another option for managing major depressive disorder (MDD) became available in October 2008 with the Food and Drug Administration’s (FDA) market clearance of NeuroStar TMS (transcranial magnetic stimulation) Therapy System. A panel of psychiatrists who have been treating patients with NeuroStar TMS Therapy in their clinics assembled for a virtual roundtable discussion regarding their experiences. In this supplement, the panel addresses the following issues: the FDA-cleared indication for use of NeuroStar TMS Therapy; logistic and staffing considerations in the outpatient setting; selecting the right patient for TMS Therapy; talking with patients and family about TMS Therapy. To give the overview a meaningful context, each panelist shares a personal account of a patient case, describing the treatment course and outcomes achieved with TMS Therapy.

Accelerated Repetitive Transcranial Magnetic Stimulation for Treatment Resistant Depression. Depression and Anxiety 27:960-963

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.

Demitrack, M.A. (2010) Transcranial Magnetic Stimulation for the Treatment of Major Depression clinical. Economic, and Practical Issues: Part II Psychopharm Review, Vol. 45, No. 8 August 2010

Part I of this two-part series (vol. 45, no. 4) discussed the clinical and economic burder of major depression; the compounding issue of treatment resistance; and cost analyses comparing transcranial magnetic stimulation (TMS) with standard clinical care (e.g., complex pharmacotherapy, electrconvulsive therapy [ECT]) for treatment resistance depression (TRD). Part II reviews practical issues in the clinical use of TMS, which have merged since its approval by the FDA for this indication.

Demitrack, M.A. (2010) Transcranial Magnetic Stimulation for the Treatment of Major Depression clinical. Economic, and Practical Issues: Part I Psychopharm Review, Vol. 45, No. 4 April 2010

This article is the first of two parts. Part I describes pervasive problems of major depression, the issue of treatment resistance and its economic impact. The article is intended to enable the reader to evaluate the epidemiology, functional health consequences, and economic burder of major depression, especially in its treatment-resistant form.

Transcranial Magnetic Stimulation in the Acute Treatment of Major Depressive Disorder: Clinical Response in an Open-Label Extension Trial. J Clin Psychiatry 69:3, March 2008

This report describes the results of an open-label extension study of active trans-cranial magnetic stimulation (TMS) in medication-resistant patients with major depressive disorder who did not benefit from an initial course of therapy in a previously reported 6-week, randomized controlled study of active versus sham TMS.