Can early treatment response serve as a predictor of antidepressant outcome of repetitive Transcranial Magnetic Stimulation?

Beck, Quincy; Tirrell, Eric; Fukuda, Andrew M.; Kokdere, Fatih; Carpenter, Linda L.

doi:10.1016/j.brs.2019.12.002

Cited by 15 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, we considered the NPV of specific symptom clusters-sleep, anxiety, and mood-and stratified subjects by severity of baseline depression. Second, we examined the predictive power of symptom changes at one week instead of two, as in previous studies (Beck et al, 2020;Feffer et al, 2018). This delimited approach permitted accurate response prediction as early as one week into treatment.…”

Section: Discussionmentioning

confidence: 99%

Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder

Mirman

Corlier

Wilson

et al. 2022

Depression and Anxiety

View full text Add to dashboard Cite

Background: Symptoms of major depressive disorder (MDD) are reported to change early in treatment with repetitive transcranial magnetic stimulation (rTMS). We evaluated early changes in sleep, anxiety, and mood as predictors of nonresponse to rTMS treatment.Methods: Three hundred twenty-nine subjects with nonpsychotic MDD completed a 6-week course of rTMS treatment. Subjects were stratified by the severity of their baseline depression, and had their overall depressive symptoms recorded every week of treatment. We evaluated lack of improvement in sleep, anxiety, and mood symptoms after 1 and 2 weeks as potential predictors of eventual nonresponse, defined as <50% improvement in compositive depressive symptoms after 6 weeks. This was measured as negative predictive value (NPV; the likelihood that lack of early symptom improvement accurately predicted eventual treatment nonresponse).Results: Subjects with severe or very severe baseline depression achieving <20% improvement in mood at 1 week were correctly predicted as nonresponders with NPVs largely >90%. At 2 weeks, subjects with very severe baseline depression who failed to demonstrate any improvement in mood were all nonresponders. Lack of improvement in sleep at 2 weeks was also a significant predictor.Conclusions: Identifying a lack of early mood improvement is a practical and robust method to predict rTMS nonresponse. This suggests a treatment protocol change may be indicated in patients with more severe baseline depression showing minimal early mood improvement.

show abstract

Section: Discussionmentioning

confidence: 99%

Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder

Mirman

Corlier

Wilson

et al. 2022

Depression and Anxiety

View full text Add to dashboard Cite

show abstract

“…Regarding the precision of the predictive capabilities, our data was comparable with previous studies in that a 20% improvement cut-off by treatment 10 achieved the best NPV as a predictor of rTMS treatment response. One study showed a NPV of 72.3% when participants failed to reach 20% improvement at week two while using final outcomes of extended treatment courses of 10 Hz stimulation at the left DLPFC ( 12 ), and another which had ~80% NPV when using 1 Hz at the left DMPFC ( 13 ). Notably, our study focused on NPV as we felt this was the most important clinical information for rTMS practitioners to consider 10 treatments into an rTMS course.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent studies examined other potential predictors of treatment response: one demonstrating a NPV of 72.3% when participants had <20% improvement at week two while using final outcomes of extended treatment courses of 10 Hz stimulation at the left dorsolateral prefrontal cortex (DLPFC) ( 12 ), and another finding a NPV of roughly 80% for a population receiving 1 Hz rTMS ( 13 ). Calculating metrics such as negative predictive value of early treatment response in clinical TMS populations allows clinicians to better prognosticate who will respond to subsequent therapy and aids in the decision making regarding altering or adapting treatment plans to optimize outcomes.…”

Section: Introductionmentioning

confidence: 99%

Early Improvement Predicts Clinical Outcomes Similarly in 10 Hz rTMS and iTBS Therapy for Depression

et al. 2022

View full text Add to dashboard Cite

BackgroundPrior studies have demonstrated that early treatment response with transcranial magnetic stimulation (TMS) can predict overall response, yet none have directly compared that predictive capacity between intermittent theta-burst stimulation (iTBS) and 10 Hz repetitive transcranial magnetic stimulation (rTMS) for depression. Our study sought to test the hypothesis that early clinical improvement could predict ultimate treatment response in both iTBS and 10 Hz rTMS patient groups and that there would not be significant differences between the modalities.MethodsWe retrospectively evaluated response to treatment in 105 participants with depression that received 10 Hz rTMS (n = 68) and iTBS (n = 37) to the dorsolateral prefrontal cortex (DLPFC). Percent changes from baseline to treatment 10 (t10), and to final treatment (tf), were used to calculate confusion matrices including negative predictive value (NPV). Treatment non-response was defined as <50% reduction in PHQ-9 scores according to literature, and population, data-driven non-response was defined as <40% for 10 Hz and <45% for iTBS.ResultsFor both modalities, the NPV related to degree of improvement at t10. NPV for 10 Hz was 80%, 63% and 46% at t10 in those who failed to improve >20, >10, and >0% respectively; while iTBS NPV rates were 65, 50, and 35%. There were not significant differences between protocols at any t10 cut-off assessed, whether research defined 50% improvement as response or data driven kernel density estimates (p = 0.22–0.44).ConclusionPatients who fail to achieve >20% improvement by t10 with both 10 Hz rTMS and iTBS therapies have ~70% chance of non-response to treatment. With no significant differences between predictive capacities, identifying patients at-risk for non-response affords psychiatrists greater opportunity to adapt treatment strategies.

show abstract

“…Based on regulatory clinical trials and FDA labeling of commercial TMS devices, most American TMS clinicians do not routinely stimulate that brain region (DMPFC), and 30 or more sessions are delivered in a typical acute course in the United States. Since prediction of nonresponse differs as a function of the total number of treatment sessions (Beck et al., 2019 ), data are still needed to determine whether patients with marked anhedonia are likely to benefit from a standard course of TMS therapy for MDD delivered to the most commonly used target (DLPFC).…”

Section: Introductionmentioning

confidence: 99%

Effects of transcranial magnetic stimulation on anhedonia in treatment resistant major depressive disorder

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background: Anhedonia is one of the defining features of depression but it remains difficult to target and treat. Transcranial magnetic stimulation (TMS) is a proven treatment for depression, but its effects on anhedonia and whether anhedonia can be used as a predictive biomarker of response is not well known.Methods: Snaith-Hamilton Pleasure Scale was administered to patients with depression before and after a standard course of TMS in a naturalistic outpatient setting.Results: 144 patients were analyzed. There was an overall significant improvement in anhedonia from pre-to post-treatment (7.69 ± 3.88 vs. 2.96 ± 3.45; p < .001).Significant correlations between improvements in anhedonia and other depressive symptoms were present (r = 0.55, p < .001). Logistic regression revealed that baseline anhedonia severity was not a significant predictor of clinical outcome. Conclusion:This is the first large, naturalistic study examining the effects of standard, non-research TMS on anhedonia. Among depressed patients, TMS resulted in significant improvements in anhedonia. Patients with severe baseline anhedonia had an equal chance of achieving clinical response/remission. Patients with anhedonia should not be excluded from treatment if they are safe for outpatient care and otherwise appropriate candidates for treatment.

show abstract

Can early treatment response serve as a predictor of antidepressant outcome of repetitive Transcranial Magnetic Stimulation?

Cited by 15 publications

References 9 publications

Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder

Absence of early mood improvement as a robust predictor of rTMS nonresponse in major depressive disorder

Early Improvement Predicts Clinical Outcomes Similarly in 10 Hz rTMS and iTBS Therapy for Depression

Effects of transcranial magnetic stimulation on anhedonia in treatment resistant major depressive disorder

Contact Info

Product

Resources

About