Journal: Brain Stimulation (2019)
Authors: Mania I, Kaur J
Background:
One of the strategies used for optimizing rTMS treatment for depression is combining rTMS with other evidence–based modalities. The use of light for depression dates back to the beginnings of civilization. Since the first description of the syndrome of Seasonal affective disorder (SAD) and light therapy in the seminal paper by Rosenthal, Bright Light Therapy (BTL) has become a widely used treatment method for SAD as well as non-seasonal depressive disorders like MDD.
Objective:
The aim of this study was to combine rTMS treatment with Bright Light Therapy in patients with severe treatment-resistant MDD.
Methods:
Six adult patients with severe treatment resistant MDD were prescribed treatment with above mentioned protocol. All had advanced treatment resistance and failed 4 or more antidepressant medications from at least two different classes and failed psychotherapy. As long as TMS was safe to administer no exclusion criteria were used in terms of medical or psychiatric co-morbidities.
Results:
All patients completed the prescribed course and tolerated treatment well without side effects. On primary efficacy measure, response and remission rates at the end of full treatment course using 17-question Hamilton Depression Rating Scale (HAM-D) were 100% and 50% respectively. On secondary efficacy measure, mean change in HAM-D score was 22.5 (SD ¼ 3.4). Mean baseline HAM-D score was 28.3 (SD ¼ 5.5) and mean endpoint HAM-D score was 5.8 (SD ¼ 3.1).
Conclusions:
Overall, patients benefited with significant response and remission rates. Further research into combining BLT with rTMS is recommended.
