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

• DOI: 10.1016/j.brs.2017.11.004
• Publication Date: 2017-11-11T04:16:28Z
• Authors: Lana Donse; Frank Padberg; Alexander T. Sack; A. John Rush; Martijn Arns
• Keywords: Adult; Male; TRANSCRANIAL MAGNETIC STIMULATION; STAR-ASTERISK-D; DORSOLATERAL PREFRONTAL CORTEX; Biophysics; Clinical Neurology; Transcranial Magnetic Stimulation/methods; DOUBLE-BLIND; 03 medical and health sciences; 0302 clinical medicine; Repetitive transcranial magnetic stimulation (rTMS); Journal Article; Humans; repetitive transcranial magnetic stimulation (rTMS); Treatment outcome; COGNITIVE-BEHAVIORAL THERAPY; METAANALYSIS; Clinical predictors; Major depressive disorder (MDD); SHAM-CONTROLLED TRIALS; Depressive Disorder; Depressive Disorder, Major; General Neuroscience; RANDOMIZED CONTROLLED-TRIAL; Major/therapy; Middle Aged; EFFICACY; Transcranial Magnetic Stimulation; 3. Good health; Psychotherapy; Psychotherapy/methods; TREATMENT-RESISTANT DEPRESSION; Cognitive-behavioral therapy (CBT); Female

Repetitive transcranial magnetic stimulation (rTMS) is considered an efficacious non-invasive neuromodulation treatment for major depressive disorder (MDD). However, little known about the clinical outcome of combined rTMS and psychotherapy (rTMS + PT). Through common neurobiological brain mechanisms, PT may exert enhanced antidepressant effects compared to respective monotherapies.The current naturalistic study aimed evaluate feasibility in a large group MDD patients. The second aim was identify predictors response remission.A total 196 patients with were treated at least 10 sessions simultaneous PT. applied over DLPFC, either Hz left or 1 right. Psychotherapy based on principles cognitive behavioral therapy (CBT). Symptoms measured using BDI each fifth session until end 6-month follow-up. Comparisons made between responders non-responders, as well protocol. Additionally, baseline variables early change evaluated response/remission.1) Combining resulted 66% 56% remission rate 60% sustained Compared previous findings RCTs, these rates are relatively high; 2) No differences found TMS regarding outcome; 3) Clinical not predictive outcomes; 4) Early symptom improvement (at 10) highly response, therefore be used guide continuation; 5) Based study, future studies employing more standardized method warranted draw solid conclusions unique effect