Journal: Brain Stimulation (2018)
Authors: Ghelber D, Khanal K
Background:
Brainsway dTMS is FDA approved for TRD. Multiple studies prove the efficacy of Ketamine in TRD. There are case reports discussing the combination between Ketamine and rTMS in TRD
Objective:
To assess the clinical impact of Brainsway dTMS and Brainsway dTMS combined with Ketamine infusions in patients with TRD.
Methods:
Over 18 months of Brainsway dTMS use in the aiuthors’ office, they treated a total of 41 TRD patients. 16 were only treated with dTMS, 25 also received Ketamine infusions. The indications for using Ketamine infusions were increased suicidal risk, severity of depression, slow improvement of symptoms, bridge to TMS approval by insurance and patient preference. Patients received 1-7 ketamine infusions, 0.5 mg/kg over 40 minutes. Beck Depression Inventory (BDI) was used to assess depression severity. 6 of the TMSK patients and 11 of the TMS patients, had an initial Beck score of at least 31, qualifying as severe-extreme depression.
Results:
24/41 (58.5%) patients went into remission (BDI<10) and 4/41 (9.75%) had minimal residual symptoms (BDI 11-16) at treatment completion. The mean BDI score pretreatment was 36.68 in TMSK vs 36.37 in TMS group (p=0.46).Post-treatment BDI score significantly decreased (P<0.05) to 9.16 (TMSK) and 13.3 (TMS). The end-treatment scores were not significantly different among the 2 groups (p=0.06). 24/41 patients had severe-extreme depression (BDI>31). Mean Beck score of severely depressed was 42.37 (TMSK) and 41.8 (TMS), p=0.3. Post treatment score in the severely depressed was 12.5 (TMSK) and 15 (TMS) p=0.4. 11 (45.8%) of the severely depressed went into remission and 3 (12.5%) had a BDI 11-16 at the end of the treatment.
Conclusions:
TMS and TMSK significantly reduce depression scores in treatment-resistant depression. Severely-extremely depressed patients are less likely to attain remission than moderately depressed patients. Adding Ketamine infusions to a dTMS protocol does not significantly change the results over dTMS alone. This could possibly be due to the small number of patients enrolled.
