Treatment expectations and clinical outcomes following repetitive transcranial magnetic stimulation for treatment-resistant depression

• DOI: 10.1016/j.brs.2024.06.006
• Publication Date: 2024-06-18T23:38:02Z
• Authors: Adriano Mollica; Enoch Ng; Matthew J. Burke; Sean M. Nestor; Hyewon Lee; Jennifer S. Rabin; Clement Hamani; Nir Lipsman; Peter Giacobbe
• Keywords: Pre-treatment expectations; 03 medical and health sciences; 0302 clinical medicine; Placebo effects; Neurosciences. Biological psychiatry. Neuropsychiatry; Treatment resistant depression; Transcranial magnetic stimulation; RC321-571

Patient expectations, including both positive (placebo) and negative (nocebo) effects, influence treatment outcomes, yet their impact on acute repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression (TRD) is unclear.In this single-center retrospective chart review, 208 TRD patients completed the Stanford Expectation of Treatment Scale (SETS) before starting open-label rTMS treatment. Patients were offered two excitatory rTMS protocols (deep TMS or intermittent theta-burst stimulation), which stimulated the left dorsolateral prefrontal cortex. A minimum of 20 once daily treatments were provided, delivered over 4-6 weeks. Primary outcomes were 1) remission, measured by a post-treatment score of <8 on the Hamilton Depression Rating Scale (HAMD-17), and 2) premature discontinuation. The change in HAMD-17 scores over time was used as a secondary outcome. Physicians were blinded to SETS scores. Logistic and linear regression, adjusting for covariates, assessed SETS and HAMD-17 relationships.Of 208 patients, 177 had baseline and covariate data available. The mean positivity bias score (positive expectancy minus negative expectancy subscale averages) was 0.48 ± 2.21, indicating the cohort was neutral regarding the expectations of their treatment on average. Higher positive expectancy scores were significantly associated with greater odds of remission (OR = 1.90, p = 0.003) and greater reduction in HAMD-17 scores (β = 1.30, p = 0.005) at the end of acute treatment, after adjusting for covariates. Negative expectancy was not associated with decreased odds of remission (p = 0.2) or treatment discontinuation (p = 0.8).Higher pre-treatment positive expectations were associated with greater remission rates with open-label rTMS in a naturalistic cohort of patients with TRD.