Clinical significance of transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant depression: Synthesis of recent data

Neuronetics, Inc., Malvern, PA, USA.
Psychopharmacology bulletin (Impact Factor: 0.5). 02/2009; 42(2):5-38.
Source: PubMed


Transcranial magnetic stimulation (TMS) is a novel treatment for patients with major depressive disorder. Although clearly safer and better tolerated than many other pharmacotherapeutic options or electroconvulsive therapy, questions have persisted about the magnitude of the efficacy of TMS in patients with pharmacoresistant depression, and the clinical significance of these outcomes. Previous studies have explored whether specific patient characteristics are associated with a greater likelihood of clinical benefit. In the largest such analysis conducted to date, the authors confirmed previous observations that the lower the number of prior failed antidepressant treatments, the better the clinical outcome of treatment with TMS. This relationship between prior treatment resistance and subsequent treatment outcome is consistent with previous evidence from antidepressant studies. The authors examined the clinical significance of the treatment effects seen with TMS in pharmacoresistant major depression in their recently completed studies by comparing these outcomes with the results reported in several large, comprehensive published reference datasets of antidepressant medications studied in both treatment-responsive and treatment-resistant patient populations. The efficacy of TMS demonstrated in randomized controlled trials was comparable to that of pharmaceutical antidepressants studied in similarly designed registration trials and to the adjunctive use of atypical antipsychotic medications in controlled trials of antidepressant non-responders. These data may be helpful in treatment-planning decisions when using TMS in clinical practice.

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Available from: Mark Demitrack, Feb 24, 2015
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    • "The results of this study cannot be formally compared to those of previous studies of rTMS or medication treatment because of the possible confounding effects of differences in study design. The degree of improvement seen in subjects receiving sTMS is similar, however, to that reported in previous treatment studies using rTMS or medications for MDD [1] [3] [47] [48]. Because the treatment can be administered without significant risk and a low rate of adverse events, sTMS may constitute a valuable neuromodulation treatment for MDD. "
    Brain Stimulation 03/2015; 8(2):404. DOI:10.1016/j.brs.2015.01.287 · 4.40 Impact Factor
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    • "Although initially it was estimated that 15-20% of patients with depression fall into the category of treatment resistant depression, the STAR-D naturalistic trial showed a rate as high as 50 % [16]. In treatment resistant depression, ECT provides fair efficacy and can help more than half of these patients [17] [18] [19] [20] [21]. ECT should be considered as a first line treatment when: • There is an urgent need for response such as in cases with severe suicidal state, or poor food and fluid intake. "
    Electroconvulsive Therapy: Clinical Uses, Efficacy and Long-Term Health Effects, Edited by Kathleen Braddock, 08/2014: chapter An Evidence-Informed Model for the Modern Practice of Electroconvulsive Therapy; NOVA scientific publisher., ISBN: 978-1-63463-038-2
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    • "For instance, treatment-resistant depression (TRD) has been defined as the lack of response to two antidepressant trials, given in succession, at adequate doses and for an adequate time frame, in compliant subjects [3]. For these patients, different treatment strategies are available, including pharmacological and psychotherapic augumentations as well as brain stimulation techniques [4]. The latters include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS) [5]. "
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    ABSTRACT: Major Depression (MD) and treatment-resistant depression (TRD) are worldwide leading causes of disability and therapeutic strategies for these impairing and prevalent conditions include pharmacological augmentation strategies and brain stimulation techniques. In this perspective, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique with a favorable profile of tolerability which, despite being recently approved by the Food and Drug Administration (FDA) for the treatment of patients with medication-refractory unipolar depression, still raises some doubts about most effective parameters of stimulation. A literature search was performed using PubMed for the years 2001 through February 2011 in order to review meta-analytic studies assessing efficacy and safety issues for rTMS in depressive disorders. Fifteen meta-analyses were identified and critically discussed in order to provide an updated and comprehensive overview of the topic with specific emphasis on potentially optimal parameters of stimulation. First meta-analyses on the efficacy of rTMS for the treatment of MD and TRD have shown mixed results. On the other hand, more recent meta-analytic studies seem to support the antidepressant efficacy of the technique to a greater extent, also in light of longer periods of stimulation (e.g. > 2 weeks). rTMS seems to be an effective and safe brain stimulation technique for the treatment of medication refractory depression. Nevertheless, further studies are needed to better define specific stimulation-related issues, such as duration of treatment as well as durability of effects and predictors of response.
    Clinical Practice and Epidemiology in Mental Health 10/2011; 7:167-77. DOI:10.2174/1745017901107010167
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