Journal: Brain Stimulation (2016)
Authors: Tendler A, Sisko ES, DeLuca M, DeLuca L, Rodriguez N, Corbett-Methot S, Sutton DeBord J
Background:
A previously published study suggests lower rates of response and remission in six patients who previously failed a course of ECT.
Objective:
To further evaluate efficacy of deep transcranial magnetic stimulation (dTMS) for patients with highly treatment resistant severe depression – those who failed electroconvulsive therapy (ECT). The intent was to determine if increased total pulses or different stimulations demonstrate improved response.
Methods:
A database of two-hundred and fifty dTMS patients’ treatment details was reviewed, for patients who failed a course of ECT. Of the twelve patients who received ECT, two were excluded from the analysis because they did not undergo an adequate dTMS treatment trial. Three of ten ECT failure patients had bipolar disorder and the remainder MDD. dTMS was administered using the H1 coil to the left dorsolateral prefrontal cortex (DLPFC) at 18 Hz, 120-150% motor threshold (MT) for 1980 to 6012 total pulses. Patients received dTMS as an augmentation to their antidepressants. Patients were assessed using their Clinical Global Impression (CGI) as the primary outcome measure. Additional outcome measures included Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Patients Health Questionnaire (PHQ).
Results:
Three patients had no response, four responded, and three fully remitted. Increasing total daily pulses and intensity improved response and remission rates.
Conclusions:
dTMS treatment with the H1 coil is efficacious even in patients who failed ECT. Further investigation is warranted to determine if increased total pulses and/or stimulation intensity is necessary for improved remission rates.
