Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study

Lana Donse, Frank Padberg, Alexander T Sack, A John Rush, Martijn Arns

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is considered an efficacious non-invasive neuromodulation treatment for major depressive disorder (MDD). However, little is known about the clinical outcome of combined rTMS and psychotherapy (rTMS + PT). Through common neurobiological brain mechanisms, rTMS + PT may exert enhanced antidepressant effects compared to the respective monotherapies.

OBJECTIVE: The current naturalistic study aimed to evaluate feasibility and clinical outcome of rTMS + PT in a large group of MDD patients. The second aim was to identify clinical predictors of response and remission.

METHODS: A total of 196 patients with MDD were treated with at least 10 sessions of simultaneous rTMS and PT. rTMS was applied over the DLPFC, either 10 Hz left or 1 Hz right. Psychotherapy was based on principles of cognitive behavioral therapy (CBT). Symptoms were measured using the BDI each fifth session until end of treatment and at 6-month follow-up. Comparisons were made between responders and non-responders, as well as between the 10 Hz and 1 Hz protocol. Additionally, baseline variables and early BDI change were evaluated as predictors of response/remission.

MAJOR FINDINGS AND CONCLUSIONS: 1) Combining rTMS and PT resulted in a 66% response and a 56% remission rate at the end of treatment with 60% sustained remission at follow-up. Compared to previous findings in RCTs, these rates are relatively high; 2) No differences were found between the 10 Hz and 1 Hz TMS regarding clinical outcome; 3) Clinical baseline variables were not predictive of treatment outcomes; 4) Early symptom improvement (at session 10) was highly predictive of response, and may therefore be used to guide rTMS + PT continuation; 5) Based on the current findings in a large naturalistic study, future studies employing a more standardized method are warranted to draw solid conclusions on the unique effect of rTMS + PT.

Original languageEnglish
Pages (from-to)337–345
Number of pages9
JournalBrain stimulation
Volume11
Issue number2
Early online date11 Nov 2017
DOIs
Publication statusPublished - Mar 2018

Keywords

  • Journal Article
  • Clinical predictors
  • Treatment outcome
  • DORSOLATERAL PREFRONTAL CORTEX
  • TREATMENT-RESISTANT DEPRESSION
  • STAR-ASTERISK-D
  • METAANALYSIS
  • EFFICACY
  • Cognitive-behavioral therapy (CBT)
  • repetitive transcranial magnetic stimulation (rTMS)
  • RANDOMIZED CONTROLLED-TRIAL
  • TRANSCRANIAL MAGNETIC STIMULATION
  • COGNITIVE-BEHAVIORAL THERAPY
  • Major depressive disorder (MDD)
  • DOUBLE-BLIND
  • SHAM-CONTROLLED TRIALS
  • Humans
  • Middle Aged
  • Male
  • Transcranial Magnetic Stimulation/methods
  • Psychotherapy/methods
  • Depressive Disorder, Major/therapy
  • Adult
  • Female

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