Journal
DEPRESSION AND ANXIETY
Volume 28, Issue 11, Pages 973-980Publisher
WILEY
DOI: 10.1002/da.20885
Keywords
transcranial magnetic stimulation; rTMS; high frequency rTMS; low frequency rTMS; treatment-resistant depression
Categories
Funding
- National Institute of Mental Health (NIMH) [5R01MH069929, 5R01MH069887, 5R01MH069896, 5R01MH069895, 5R01MH069886]
- St. Jude Medical Neuromodulation
- AvaCat Consulting
- Tetragenex
- Neuronetics
- Advanced Neuromodulatory Systems
- Brainsway
- Cyberonics
- Takeda
- MECTA Corporation
- Medtronic
- PureTech Ventures
- NeoStim and NeoSync
- Brainsonix
- Cephos
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Objective: To assess the efficacy of increasing the number of fast left repetitive transcranial magnetic stimulations (rTMS) (10 Hz @ 120% of motor threshold (MT) over the left dorsolateral prefrontal cortex (DLPFC)) needed to achieve remission in treatment-resistant depression (TRD). And, to determine if patients who do not remit to fast left will remit using slow right rTMS (1 Hz @ 120% MTover the right DLPFC). Method: Patients were part of a multicenter sham-controlled trial investigating the efficacy of fast left rTMS. Patients who failed to meet minimal response criteria in the sham-controlled study could enroll in this open fast left rTMS study for an additional 3-6 weeks. Patients who failed to remit to fast left could switch to slow right rTMS for up to 4 additional weeks. The final outcome measure was remission, defined as a HAM-D score of < 3 or 2 consecutive HAM-D scores less than 10. Results: Forty-three of 141 (30.5%) patients who enrolled in the open phase study eventually met criteria for remission. Patients who remitted during fast left treatment received a mean of 26 active treatments (90,000 pulses). Twenty-six percent of patients who failed fast left remitted during slow right treatment. Conclusion: The total number of rTMS stimulations needed to achieve remission in TRD may be higher than is used in most studies. TRD patients who do not respond to fast left rTMS may remit to slow right rTMS or additional rTMS stimulations. Depression and Anxiety 28: 973-980, 2011. (C) 2011 Wiley Periodicals, Inc.
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