Journal: Brain Stimulation (2015)
Authors: Duffy W, Choudhry Z, Rajamani M, Nathan R, Siddiqui W, Waris M
Background:
Electroconvulsive Therapy (ECT) is believed to be an effective treatment for treatment resistant depression (TRD). However, ECT has been associated with major side-effects including cognitive sequel. Alternatively, deep Transcranial Magnetic Stimulation (dTMS) is another effective treatment for alleviating MDD symptoms. Reports comparing efficacy of ECT and dTMS yield mixed results. Thus, most clinicians administer ECT in TRD patients prior to dTMS treatment. However, a recent study highlighted the possibility of a subpopulation of depressed patients who did not benefit from prior ECT treatment but subsequently benefited from dTMS treatment.
Objective:
To examine the relationship between prior ECT treatment and dTMS treatment outcomes in MDD patients.
Methods:
80 patients (27% male) with MDD, ages 24-84 years (mean=46.85), previously failing 1-8 medication regimens (mean=4.23) received dTMS using H-coil technology. Symptom severity was assessed using PHQ-9 scores at baseline and every 5 treatments subsequently. Patients received an acute phase dTMS treatment (20 sessions), and also received further maintenance treatment (10 sessions). Effect of Prior Lifetime ECT (PL-ECT) on modulating dTMS efficacy was evaluated using Repeated Measure ANOVA to contrast baseline, acute and maintenance paradigms. Response (<10 or >50% from baseline) and remission (<5) were calculated.
Results:
A significant dTMS treatment effect (p=0.000) on MDD symptom severity was observed in both paradigms for all study subjects. However, no significant effect of PL-ECT was observed on modulating dTMS treatment response in both post-acute and maintenance phases (p=0.963; p=0.734).
Conclusions:
These results suggest that, exposed and unexposed PL-ECT MDD subjects equally benefit from both dTMS treatment paradigms. However, further research is warranted to reach firmer conclusions.
