Journal article
Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study
Journal of psychiatry & neuroscience, Vol.41(4), pp.E58-E66
07/01/2016
DOI: 10.1503/jpn.150265
PMCID: PMC4915938
PMID: 27269205
Abstract
Background: Several factors may mitigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) over sham rTMS in patients with treatment-resistant depression (TRD). These factors include unilateral stimulation (i.e., treatment of only the left dorsolateral prefrontal cortex [DLPFC]), suboptimal methods of targeting the DLPFC and insufficient stimulation intensity (based on coil-to-cortex distance). Methods: We recruited patients with TRD between the ages of 18 and 85 years from a university hospital, and participants were randomized to receive sequential bilateral rTMS (600 pulses at 1 Hz followed by 1500 pulses at 10 Hz), unilateral high-frequency left (HFL)-rTMS (2100 pulses at 10 Hz) or sham rTMS for 3 or 6 weeks depending on treatment response. Stimulation was targeted with MRI localization over the junction of the middle and anterior thirds of the middle frontal gyrus, using 120% of the coil-to-cortex adjusted motor threshold. Our primary outcome of interest was the remission rate. Results: A total of 121 patients participated in this study. The remission rate was significantly higher in the bilateral group than the sham group. The remission rate in the HFL-rTMS group was intermediate and did not differ statistically from the rate in the 2 other groups. There were no significant differences in reduction of depression scores among the 3 groups. Limitations: The number of pulses used per session in the unilateral group was somewhat lower in our trial than in more recent trials, and the sham condition did not involve active stimulation. Conclusion: Our findings suggest that sequential -bilateral rTMS is superior to sham rTMS; however, adjusting for coil-to-cortex distance did not yield enhanced efficacy rates.
Details
- Title: Subtitle
- Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study
- Creators
- Daniel M. Blumberger - Centre for Addiction and Mental HealthJerome J. Maller - Monash Alfred Psychiatry Research centreLauren Thomson - University of British ColumbiaBenoit H. Mulsant - University of British ColumbiaTarek K. Rajji - University of TorontoMissy Maher - University Health NetworkPatrick E. Brown - University of British ColumbiaJonathan Downar - University of British ColumbiaFidel Vila-Rodriguez - Cancer Care OntarioPaul B. Fitzgerald - University of British ColumbiaZafiris J. Daskalakis - Centre for Addiction and Mental Health
- Resource Type
- Journal article
- Publication Details
- Journal of psychiatry & neuroscience, Vol.41(4), pp.E58-E66
- DOI
- 10.1503/jpn.150265
- PMID
- 27269205
- PMCID
- PMC4915938
- NLM abbreviation
- J Psychiatry Neurosci
- ISSN
- 1180-4882
- eISSN
- 1488-2434
- Publisher
- Cma-Canadian Medical Assoc
- Number of pages
- 9
- Grant note
- Sepracor Inc Brain Canada NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Bristol-Myers Squibb Brain and Behaviour Research Foundation Toronto General and Western Hospital Foundation 606907 / NHMRC Practitioner Fellowship; National Health & Medical Research Council (NHMRC) of Australia Brainsway Ltd Ontario Mental Health Foundation (OMHF) Lundbeck; Lundbeck Corporation
- Language
- English
- Date published
- 07/01/2016
- Academic Unit
- Radiology
- Record Identifier
- 9984848504502771
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