Journal: Brain Stimulation (2014)
Authors: Hovav S, Kinback K
Background:
Deep Transcranial Magnetic Stimulation (dTMS) received FDA clearance in 2013 for the treatment of depression. As of yet, there are no post-marketing outcome data in “real world” practices.
Objective:
To examine a retrospective cohort of ten patients, ages 20-74, who received dTMS for treatment-resistant major depressive disorder with an additional protocol aimed at treating their comorbid anxiety.
Methods:
Patients received 20 sessions of dTMS over a 4-week period using the H1-Coil, which preferentially stimulates the left prefrontal region at 18Hz. Patients received an average of 73 trains (higher than the standard 55), followed by a right-sided protocol at 1Hz (average of 183 pulses) for comorbid anxiety. Depression outcomes were assessed using the PHQ-9 and Hamilton Depression Rating Scale (HAM-D). Anxiety outcome was measured by question 10 on the HAM-D.
Results:
Group changes were assessed by paired t-test comparing baseline and final values at the end of 4 weeks. Statistical significance was set at p<0.05, two-tailed. Patients showed significant improvement in depression on the PHQ-9 from baseline (M=16.70, SD=5.52) to end (M=11.6, SD=4.33); t(9)=3.36, p=0.008. Similar results were found on the HAM-D prior (M=21.0, SD=4.00) and following (M=11.6, SD=3.81); t(9)=6.87, p<0.001. Anxiety was also significantly improved from baseline (M=2.3, SD=1.06) to end (M=1.2, SD=0.63); (t(9)=3.97, p=0.003).
Conclusions:
This is the first published report of dTMS administered with suprathreshold stimulation on the left with the addition of right-sided treatment. The results show significant improvement in depression and anxiety using this novel pulse sequence. Augmented TMS protocols used earlier in the illness course may prevent complex polypharmacy, ECT, or inpatient hospitalization. Formal, prospective studies are needed to determine standardized dTMS protocols.
