Academic journal article Indian Journal of Psychiatry

Effectiveness of Adjunctive Repetitive Transcranial Magnetic Stimulation in Management of Treatment-Resistant Depression: A Retrospective Analysis

Academic journal article Indian Journal of Psychiatry

Effectiveness of Adjunctive Repetitive Transcranial Magnetic Stimulation in Management of Treatment-Resistant Depression: A Retrospective Analysis

Article excerpt

Byline: Rohit. Verma, Nand. Kumar, Saurabh. Kumar

Background: There is limited number of studies from India investigating role of repetitive transcranial magnetic stimulation (rTMS) in treatment-resistant depression (TRD). This clinic-based study reports on the efficacy of rTMS as an add-on treatment in patients suffering from TRD. Materials and Methods: Twenty-two right-handed patients suffering from major depressive disorder who failed to respond to adequate trials of at least two antidepressants drugs in the current episode received rTMS as an augmenting treatment. High-frequency (Hf) rTMS at 110% of the estimated resting motor threshold (MT) was given over the left dorsolateral prefrontal cortex (DLPFC). A total of 15 sessions were given over 3 weeks with 3000 pulses per session. The outcome was assessed based on the changes in scores of Hamilton Rating Scale for Depression or Montgomery-Asberg Depression Rating Scale. Results: There was a significant reduction in final assessment scores after rTMS intervention as compared to baseline with almost 50% of the participants showing response in either scale. Conclusion: Hf rTMS applied over left DLPFC is an effective add-on treatment strategy in patients with TRD.

Introduction

Depression is one of the most prevalent and disabling disorders worldwide. Unipolar major depression accounts for 4.3% of the global burden of disease and is the third leading cause of disease burden, which is projected to be leading cause of disease burden globally by the year 2030.[1] Indian data estimates the prevalence of depression to be about 15%, similar to the worldwide literature.[2]

Wide ranges of treatment options are available for depression ranging from biological treatments to psychotherapy, but despite all therapeutic options a significant proportion of patients fail to respond to these treatments. Different studies have shown that even if conservative estimates are taken, almost one-fifth of the patients continue to suffer from depression after multiple drug trials.[3] Several published randomized controlled trials and meta-analysis have shown repetitive transcranial magnetic stimulation (rTMS) to be an effective treatment modality in the management of patients suffering from treatment-resistant depression (TRD). The majority of studies have targeted left dorsolateral prefrontal cortex (DLPFC) as an area of stimulation since several studies have shown that patients suffering from depression have decreased neuronal activity as well as decreased metabolism in these regions or in the regions closely connected to them like rostral anterior cingulate cortex.[4],[5] High frequency (Hf) rTMS have been shown to increase the local cortical neuronal activity and modulate the activity of local inhibitory circuits. It can bring changes in the levels of neurotransmitters as well as increase the local brain metabolism.[6]

There have been only few published studies from India investigating the role of rTMS in depression. This paper reports on the efficacy of rTMS as an add-on treatment in patients who were suffering from TRD.

Materials and Methods

The Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, runs a rTMS clinic once a week where detailed evaluation of patients suffering from various psychiatric disorders is done to assess their suitability for this intervention and rTMS sessions are given in the Transcranial Magnetic Stimulation laboratory for 5 days a week. In this paper, we are reporting clinic-based data of group of patients who were suffering from major depressive disorder according to the International Classification of Diseases version 10 and completed 15 sessions of rTMS between August 2009 and December 2015. These patients failed to respond to at least two antidepressant medication trials given for at least 6-8 weeks at adequate dose. All the patients undergoing the rTMS intervention were screened on a pro forma for having any condition that can preclude the safe use of rTMS and were excluded if they suffered from any such condition. …

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