A Randomized, Controlled Trial of Sequential Bilateral Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression

Fitzgerald, Paul B.; Mendieta, Jessica Benitez; Castella, Anthony de; Daskalakis, Zafiris J.; Brown, Timothy L.; Kulkarni, Jayashri

doi:10.1176/appi.ajp.163.1.88

Cited by 319 publications

(224 citation statements)

References 24 publications

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“…First, the results may have been confounded by non-specific effects given that we have not included a sham control group. Second, whilst we have provided treatment for 4 weeks, studies are now testing rTMS methods over longer periods of time (Fitzgerald et al, 2006a;O'Reardon et al, 2007). It is possible that the standard group could 'catch up' in their response rates with a longer duration of treatment, although there is no clear rationale as to why targeting would accelerate rather than enhance responses.…”

Section: Comorbid/diagnosesmentioning

confidence: 99%

“…Repetitive transcranial magnetic stimulation (rTMS), applied to the dorsolateral prefrontal cortex (DLPFC), has been investigated actively as an alternative intervention for patients with treatment-resistant depression (TRD) (eg George et al, 1995George et al, , 2000Fitzgerald et al, 2003Fitzgerald et al, , 2006a. Most trials have suggested that the active rTMS treatment has greater antidepressant efficacy than sham stimulation (Fitzgerald, 2006), including a large international multi-site trial (O'Reardon et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Randomized Trial of rTMS Targeted with MRI Based Neuro-Navigation in Treatment-Resistant Depression

Fitzgerald

Hoy

McQueen

et al. 2009

Neuropsychopharmacol

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344

218

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The aim of this study is to investigate whether repetitive transcranial magnetic stimulation (rTMS) targeted to a specific site in the dorsolateral prefrontal cortex (DLPFC), with a neuro-navigational method based on structural MRI, would be more effective than rTMS applied using the standard localization technique. Fifty-one patients with treatment-resistant depression were randomized to receive a 3-week course (with a potential 1-week extension) of high-frequency (10 Hz) left-sided rTMS. Thirty trains (5 s duration) were applied daily 5 days per week at 100% of the resting motor threshold. Treatment was targeted with either the standard 5 cm technique (n ¼ 27) or using a neuro-navigational approach (n ¼ 24). This involved localizing the scalp location that corresponds to a specific site at the junction of Brodmann areas 46 and 9 in the DLPFC based on each individual subject's MRI scan. There was an overall significant reduction in the Montgomery-Asberg Depression Rating Scale scores over the course of the trial, and a better outcome in the targeted group compared with the standard localization group at 4 weeks (p ¼ 0.02). Significant differences were also found on secondary outcome variables. The use of neuro-navigational methods to target a specific DLPFC site appears to enhance response to rTMS treatment in depression. Further research is required to confirm this in larger samples, or to establish whether an alternate method based on surface anatomy, including measurement from motor cortex, can be substituted for the standard 5 cm method.

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Section: Comorbid/diagnosesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of rTMS Targeted with MRI Based Neuro-Navigation in Treatment-Resistant Depression

Fitzgerald

Hoy

McQueen

et al. 2009

Neuropsychopharmacol

Self Cite

344

218

View full text Add to dashboard Cite

show abstract

“…In total, we retained 19 RCTs in our meta-analysis [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] , totaling 181 patients with bipolar disorder (type I, N540; type II, N520; unspecified, N5121). The RCTs employed different stimulation targets: the left dorsolateral prefrontal cortex (DLPFC) [1][2][3][4][5][6][9][10][11]13,16,17 , the right DLPFC 8,14,15,18 , or bilateral DLPFC 7,12,17,19 .…”

mentioning

confidence: 99%

“…The RCTs employed different stimulation targets: the left dorsolateral prefrontal cortex (DLPFC) [1][2][3][4][5][6][9][10][11]13,16,17 , the right DLPFC 8,14,15,18 , or bilateral DLPFC 7,12,17,19 . The majority of studies delivered high-frequency stimulation (HFS) 1,3-6,9-13,16,18 , while some delivered low-frequency stimulation (LFS) 3 The issue of treatment-emergent affective switches in managing bipolar depression is important and controversial, and extends to neuromodulatory treatments.…”

mentioning

confidence: 99%

Clinical efficacy and safety of repetitive transcranial magnetic stimulation in acute bipolar depression

et al. 2016

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“…Regarding left vs. right stimulation, the accumulated evidence favors the former as more studies were performed stimulating the left DLP-FC 74 ; and the evidence for low-frequency right DLPFC is mixed [75][76][77] . However, low-frequency rTMS seems to be better tolerated 78 and might be an interesting approach in selected cases.…”

Section: Parameters Of Stimulationmentioning

confidence: 99%

Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

Brunoni

Teng

Correa³

et al. 2010

Arq. Neuro-Psiquiatr.

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The use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). Method: We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD. results: The state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them. Discussion: ECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches. Key words: comprehensive review, major depressive disorder, ECT, TMS, clinical guidelines.Estratégias de neuromodulação para o tratamento da depressão maior: desafios e recomendações de uma força-tarefa rEsuMo O uso de técnicas de neuromodulação para o tratamento do transtorno depressivo maior (TDM) tem despertado um renovado interesse nos últimos anos com o desenvolvimento de outras intervenções não-farmacólogicas além da eletroconvulsoterapia (ECT), como a estimulação magnética transcraniana (EMT), a estimulação transcraniana por corrente continua (ETCC), a estimulação cerebral profunda (DBS) e a estimulação de nervo vago (VNS). Método: Nós organizamos um grupo de trabalho com vários pesquisadores para discutir os avanços recentes e os principais desafios para o uso da neuromodulação no tratamento os principais desafios da pesquisa na neuromodulação e alternativas para superá-los. Discussão: ECT é o tratamento de primeira linha para depressão grave. EMT e ETCC são estratégias com um perfil benigno de efeitos adversos; contudo, enquanto os efeitos da EMT são comparáveis ao das drogas antidepressivas para o tratamento da TDM, a eficácia da ETCC ainda precisa ser estabelecida por mais pesquisas clínicas. DBS e VNS são intervenções invasivas com um papel possível para a depressão refratária. Em resumo, TDM é uma condição crônica, incapacitante e de alta prevalência; portanto na prática clínica todas as opções de tratamento possíveis, incluindo as farmacológicas e não-farmacológicas, devem ser consideradas. Palavras-chave: artigo de revisão, tra...

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A Randomized, Controlled Trial of Sequential Bilateral Repetitive Transcranial Magnetic Stimulation for Treatment-Resistant Depression

Cited by 319 publications

References 24 publications

A Randomized Trial of rTMS Targeted with MRI Based Neuro-Navigation in Treatment-Resistant Depression

A Randomized Trial of rTMS Targeted with MRI Based Neuro-Navigation in Treatment-Resistant Depression

Clinical efficacy and safety of repetitive transcranial magnetic stimulation in acute bipolar depression

Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

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