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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

ABSTRACT 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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    ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) has been applied in a variety of diseases due to the clinical effects through the plasticity of the brain. The effects of TMS appear differently depending on the methods of stimulation. Single pulse TMS depolarizes and discharges nerves temporally under the cortex areas stimulated, whereas rTMS induces long-lasting effects of nerves stimulated. According to the intensity of stimulation, the direction of coil and stimulation frequency, rTMS can increase or decrease the excitability of the corticospinal tract and has been verified as techniques to treat a variety of neuropsychiatric disorders. In rTMS studies using electroencephalogram (EEG), changes in brain waves have been measured before and after TMS or simultaneously during TMS. In these studies, low-frequency (≤1 Hz) rTMS, high-frequency (5-25 Hz) rTMS, theta burst stimulation, paired association stimulation have been studied and somatosensory, visual, cognitive, and motor potentials and oscillatory activities were measured and compared before and after TMS. Combined with neurophysiological and, neuroimaging methods, TMS techniques could be used to study cortical excitability, cortical inhibition and excitement, and the cortical plasticity of local areas and neural network. In particular, because simultaneous measurement during TMS as well as measurement before and after TMS is possible, EEG could be very useful to determine the effects of TMS compared to other brain imaging tools. Korean J Psychopharmacol 2013;24:160-171 Key WordszzSingle pulse transcranial magnetic stimulation · Repetitive transcranial magnetic stimulation · Electroencephalogram · Theta burst stimulation · Paired association stimulation.
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    ABSTRACT: : The efficacy of repetitive transcranial magnetic stimulation (rTMS) has been poorly investigated in the long-term. The present follow-up study was aimed to assess the long-term efficacy and the discontinuation effects of rTMS in a sample of depressed bipolar patients. : After the completion of an acute trial with augmentative, low-frequency, navigated rTMS, 11 drug-resistant depressed bipolar subjects (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [Text Revision] criteria) entered a naturalistic follow-up with monthly evaluations through the Hamilton Depression Rating Scale and the Young Mania Rating Scale. : After 1 year of follow-up, results showed that the achievement of remission after acute rTMS was predictive of maintenance of response at 1 year. On the other hand, the absence of acute rTMS response predicted the absence of subsequent response in the long-term. : This first report on the long-term discontinuation effects after acute rTMS suggests that immediate remission is predictive of sustained benefit after 1 year. Larger controlled studies are needed to confirm present preliminary findings.
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