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A pilot investigation of accelerated deep transcranial magnetic stimulation protocols in treatment-resistant depression

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Abstract

Accelerated repetitive transcranial magnetic stimulation (rTMS) protocols are being increasingly studied because of their potential to provide quicker and enhanced treatment efficacy. However, there is a lack of accelerated deep TMS with H1-coil (adTMS) treatment research. This randomized pilot study investigated the efficacy and safety of adTMS protocols. Twenty-eight TRD patients received 20-min sessions twice daily for 10 or 15 days. Primary outcomes were changes in Hamilton Depression Rating Scale (HDRS) scores and discontinuation because of adverse events (AE). Secondary outcomes were response, remission, daily changes in Beck Depression Inventory-II (BDI-II) scores, and AE incidence. HDRS scores decreased by 13 (95% CI 11–17; 59%, 95% CI 45–73%) and 13 (95% CI 11–14; 62%, 95% CI 54–69%) points in the 10- and 15-day protocols, respectively. The adjusted difference between the two protocols was not significant or clinically relevant. Remission was achieved by 38% and 42% after 10-day and 15-day protocols, respectively. The intervention was discontinued because of AEs in 3/33 (9%) patients. The BDI-II decreases were significant and clinically relevant during the first 8 days. Twice-daily adTMS for 10 days seems to be safe and effective, with rapid clinical benefits during the first week of treatment. These promising results warrant further investigation in larger randomized clinical trials comparing adTMS with the standard dTMS protocol.

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References

  1. World Health Organization (2017) Depression and other common mental disorders: global health estimates. World Health Organization, Geneva

    Google Scholar 

  2. Akil H, Gordon J, Hen R et al (2018) Treatment resistant depression: a multi-scale, systems biology approach. Neurosci Biobehav Rev 84:272–288. https://doi.org/10.1016/j.neubiorev.2017.08.019

    Article  Google Scholar 

  3. Fried EI, Nesse RM (2015) Depression is not a consistent syndrome: an investigation of unique symptom patterns in the STAR*D study. J Affect Disord 172:96–102. https://doi.org/10.1016/j.jad.2014.10.010

    Article  PubMed  Google Scholar 

  4. Firth J, Siddiqi N, Koyanagi A et al (2019) The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 6:675–712. https://doi.org/10.1016/S2215-0366(19)30132-4

    Article  PubMed  Google Scholar 

  5. Murphy JA, Sarris J, Byrne GJ (2017) A review of the conceptualisation and risk factors associated with treatment-resistant depression. Depress Res Treat 2017:4176825. https://doi.org/10.1155/2017/4176825

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kessler RC, Bromet EJ (2013) The epidemiology of depression across cultures. Annu Rev Public Health 34:119–138. https://doi.org/10.1146/annurev-publhealth-031912-114409

    Article  PubMed  PubMed Central  Google Scholar 

  7. De Carlo V, Calati R, Serretti A (2016) Socio-demographic and clinical predictors of non-response/non-remission in treatment resistant depressed patients: a systematic review. Psychiatry Res 240:421–430. https://doi.org/10.1016/j.psychres.2016.04.034

    Article  PubMed  Google Scholar 

  8. American Psychiatric Association (2016) The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. American Psychiatric Association, New York

    Book  Google Scholar 

  9. Baeken C, Brem A-K, Arns M et al (2019) Repetitive transcranial magnetic stimulation treatment for depressive disorders: current knowledge and future directions. Curr Opin Psychiatry 32:409–415. https://doi.org/10.1097/YCO.0000000000000533

    Article  PubMed  PubMed Central  Google Scholar 

  10. Philip NS, Barredo J, van ’t Wout-Frank M et al (2018) Network mechanisms of clinical response to transcranial magnetic stimulation in posttraumatic stress disorder and major depressive disorder. Biol Psychiatry 83:263–272. https://doi.org/10.1016/j.biopsych.2017.07.021

    Article  PubMed  Google Scholar 

  11. Philip NS, Barredo J, Aiken E, Carpenter LL (2018) Neuroimaging mechanisms of therapeutic transcranial magnetic stimulation for major depressive disorder. Biol Psychiatry Cogn Neurosci Neuroimaging 3:211–222

    PubMed  Google Scholar 

  12. Roth Y, Amir A, Levkovitz Y, Zangen A (2007) Three-dimensional distribution of the electric field induced in the brain by transcranial magnetic stimulation using figure-8 and deep H-coils. J Clin Neurophysiol 24:31–38. https://doi.org/10.1097/WNP.0b013e31802fa393

    Article  PubMed  Google Scholar 

  13. Levkovitz Y, Isserles M, Padberg F et al (2015) Efficacy and safety of deep transcranial magnetic stimulation for major depression: a prospective multicenter randomized controlled trial. World Psychiatry 14:64–73. https://doi.org/10.1002/wps.20199

    Article  PubMed  PubMed Central  Google Scholar 

  14. Filipčić I, Šimunović Filipčić I, Milovac Ž et al (2019) Efficacy of repetitive transcranial magnetic stimulation using a figure-8-coil or an H1-Coil in treatment of major depressive disorder; a randomized clinical trial. J Psychiatr Res 114:113–119. https://doi.org/10.1016/j.jpsychires.2019.04.020

    Article  PubMed  Google Scholar 

  15. Sonmez AI, Camsari DD, Nandakumar AL et al (2019) Accelerated TMS for depression: a systematic review and meta-analysis. Psychiatry Res 273:770–781. https://doi.org/10.1016/j.psychres.2018.12.041

    Article  PubMed  Google Scholar 

  16. Fitzgerald PB, Hoy KE, Elliot D et al (2018) Accelerated repetitive transcranial magnetic stimulation in the treatment of depression. Neuropsychopharmacology 43:1565–1572. https://doi.org/10.1038/s41386-018-0009-9

    Article  PubMed  PubMed Central  Google Scholar 

  17. (2013) World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 310:2191–4. https://doi.org/10.1001/jama.2013.281053

  18. Lecrubier Y, Sheehan D, Weiller E et al (1997) The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliablility and validity according to the CIDI. Eur Psychiatry 12:224–231

    Article  Google Scholar 

  19. Sheehan DV, Lecrubier Y, Sheehan KH et al (1998) The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 2):22–33 (quiz 34–57)

    PubMed  Google Scholar 

  20. Thase ME, Rush AJ (1997) When at first you don’t succeed: sequential strategies for antidepressant nonresponders. J Clin Psychiatry 20:23–29

    Google Scholar 

  21. Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133:429–435

    Article  CAS  Google Scholar 

  22. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatr 23:20

    Google Scholar 

  23. Beck A, Steer R, Brown G (1996) Manual for Beck Depression Inventory-II. Psychological Corporation, San Antonio

    Google Scholar 

  24. Jakšić N, Ivezić E, Jokić-Begić N et al (2013) Factorial and diagnostic validity of the Beck Depression Inventory-II (BDI-II) in Croatian primary health care. J Clin Psychol Med Settings 20:311–322. https://doi.org/10.1007/s10880-013-9363-2

    Article  PubMed  Google Scholar 

  25. Buysse DJ, Reynolds CF, Monk TH et al (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  CAS  Google Scholar 

  26. Bobo WV, Angleró GC, Jenkins G et al (2016) Validation of the 17-item Hamilton Depression Rating Scale definition of response for adults with major depressive disorder using equipercentile linking to Clinical Global Impression scale ratings: analysis of Pharmacogenomic Research Network Antidepressa. Hum Psychopharmacol 31:185–192. https://doi.org/10.1002/hup.2526

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Morley S, Dowzer C (2014) Manual for The Leeds Reliable Change Indicator: excel applications for the analysis of individual patient and group data

  28. Schulze L, Feffer K, Lozano C et al (2017) Number of pulses or number of sessions? An open-label study of trajectories of improvement for once-vs. twice-daily dorsomedial prefrontal rTMS in major depression. Brain Stimul 11:327–336. https://doi.org/10.1016/j.brs.2017.11.002

    Article  PubMed  Google Scholar 

  29. Holtzheimer PE, McDonald WM, Mufti M et al (2010) Accelerated repetitive transcranial magnetic stimulation for treatment-resistant depression. Depress Anxiety 27:960–963. https://doi.org/10.1002/da.20731

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nutt DJ, Wilson S, Paterson L (2008) Sleep disorders as core symptoms of depression. Dialogues Clin Neurosci 10:329–336

    Article  Google Scholar 

  31. Stickley A, Leinsalu M, DeVylder JE et al (2019) Sleep problems and depression among 237 023 community-dwelling adults in 46 low- and middle-income countries. Sci Rep. https://doi.org/10.1038/s41598-019-48334-7

    Article  PubMed  PubMed Central  Google Scholar 

  32. Sonmez AI, Kucuker MU, Lewis CP et al (2020) Improvement in hypersomnia with high frequency repetitive transcranial magnetic stimulation in depressed adolescents: preliminary evidence from an open-label study. Prog Neuropsychopharmacol Biol Psychiatry 97:109763. https://doi.org/10.1016/j.pnpbp.2019.109763

    Article  PubMed  Google Scholar 

  33. Rosenquist PB, Krystal A, Heart KL et al (2013) Left dorsolateral prefrontal transcranial magnetic stimulation (TMS): sleep factor changes during treatment in patients with pharmacoresistant major depressive disorder. Psychiatry Res 205:67–73. https://doi.org/10.1016/j.psychres.2012.09.011

    Article  PubMed  Google Scholar 

  34. Antczak JM, Poleszczyk A, Wichniak A et al (2017) The influence of the repetitive transcranial magnetic stimulation on sleep quality in depression. Psychiatr Pol 51:845–857. https://doi.org/10.12740/PP/68503

    Article  PubMed  Google Scholar 

  35. Shafer AB (2006) Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. J Clin Psychol 62:123–146. https://doi.org/10.1002/jclp.20213

    Article  PubMed  Google Scholar 

  36. Huang C, Chen J-H (2015) Meta-analysis of the factor structures of the Beck Depression Inventory-II. Assessment 22:459–472. https://doi.org/10.1177/1073191114548873

    Article  PubMed  Google Scholar 

  37. Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004) The Hamilton Depression Rating Scale: has the gold standard become a lead weight? Am J Psychiatry 161:2163–2177. https://doi.org/10.1176/appi.ajp.161.12.2163

    Article  PubMed  Google Scholar 

  38. Fried E, van Borkulo C, Epskamp S et al (2016) Measuring depression over time … Or not? Lack of unidimensionality and longitudinal measurement invariance in four common rating scales of depression. Psychol Assess 28:1354–1367

    Article  Google Scholar 

Download references

Funding

Croatian Health Insurance Fund funded the treatments and all other costs were covered by Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia. There were no commercial or financial involvements relevant to this study.

Author information

Author notes

  1. Igor Filipčić and Ivona Šimunović Filipčić are equal contributors and share first authorship.

Authors and Affiliations

  1. Psychiatric Hospital “Sveti Ivan”, Jankomir 11, pp 68, 10 090, Zagreb, Croatia

    Igor Filipčić, Strahimir Sučić, Željko Milovac, Natko Gereš, Katarina Matić, Mirela Čelić-Ružić, Sandra Zečević Penić, Ivana Orgulan, Vladimir Požgaj & Žarko Bajić

  2. Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia

    Igor Filipčić

  3. School of Medicine, University of Zagreb, Zagreb, Croatia

    Igor Filipčić

  4. Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia

    Ivona Šimunović Filipčić

Authors
  1. Igor Filipčić
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  2. Ivona Šimunović Filipčić
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  3. Strahimir Sučić
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Contributions

Conceptualization IF, IŠF, ŽB; formal analysis and investigation: IF, IŠF, ŽB, ŽM, SS, TG, NG, KM, IO; writing—original draft preparation: IF, IŠF, ŽB; writing—review and editing: IF, IŠF, ŽB, ŽM, TG, NG, SZP, IO; funding acquisition: IF; resources: IF, ŽM, TG, IO; supervision: IF.

Corresponding author

Correspondence to Igor Filipčić.

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Conflict of interest

IF has received equipment for research from Brainsway. He has served on a scientific advisory board for Janssen and Brainsway and received personal fee from Eli Lilly and Company, Lundbeck, Pfizer, TEVA, Belupo. For the remaining authors, no conflicts of interest were declared.

Ethical standards

The study protocol was approved by the Ethics committee of the Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia, and all participants verified their informed consent by signing the Consent form. We have not obtained an independent Ethics committee approval. This pilot study was part of the main randomized controlled trial whose protocol was registered at ClinicalTrials.gov (NCT03718013) on October 24, 2018. The study was conducted in compliance with the World Health Organization Declaration of Helsinki of 1975, as revised in 2013 [17].

Additional information

Communicated by Andrea Schmitt.

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Filipčić, I., Šimunović Filipčić, I., Sučić, S. et al. A pilot investigation of accelerated deep transcranial magnetic stimulation protocols in treatment-resistant depression. Eur Arch Psychiatry Clin Neurosci 271, 49–59 (2021). https://doi.org/10.1007/s00406-020-01141-y

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  • DOI: https://doi.org/10.1007/s00406-020-01141-y

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