Effectiveness of Transcranial Magnetic Stimulation in Clinical Practice Post-FDA Approval in the United States

Connolly, K. Ryan; Helmer, Amanda; Cristancho, Mario A.; Cristancho, Pilar; O’Reardon, John P.

doi:10.4088/jcp.11m07413

Cited by 154 publications

(54 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…TMS uses brief magnetic field pulses to induce electrical currents in the cerebral cortex, which impacts a number of processes involved in brain function (Chervyakov et al, 2015). TMS for TRD in the general adult population has demonstrated safety, tolerability, and efficacy in multiple randomized controlled trials (e.g., George et al, 2010; Levkovitz et al, 2015; O'Reardon et al, 2007); similar outcomes have been reported in naturalistic effectiveness research (Carpenter et al, 2012) and retrospective case reviews (Connolly et al, 2012). However, TMS outcomes among older adults (≥60 years) with TRD remain unclear.…”

Section: Introductionmentioning

confidence: 66%

Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients

Conelea

Philip

Yip

et al. 2017

Journal of Affective Disorders

View full text Add to dashboard Cite

Background Repetitive transcranial magnetic stimulation (TMS) has been shown to be safe and effective for treatment-resistant depression (TRD) in the general adult population. Efficacy among older (≥60 years) patients, who have a greater burden of cognitive, physical, and functional impairment compared to their younger counterparts, remains unclear. The current study aimed to characterize antidepressant response to an acute course of TMS therapy among patients aged ≥60 years compared to those < 60 years in naturalistic clinical practice settings. Methods Data were retrospectively collected and pooled for adults with TRD (N =231; n =75 aged ≥60 years and n = 156 < 60 years) who underwent an acute course of outpatient TMS therapy at two outpatient clinics. Self-report depression scales were administered at baseline and end of acute treatment. Change on continuous measures and categorical outcomes were compared across older vs. younger patients. Results Both age groups showed significant improvements in depression symptoms. Response and remission rates did not differ between groups. Age group was not a significant predictor of change in depression severity, nor of clinical response or remission, in a model controlling for other predictors (all p>.05). Limitations Limitations include reliance on self-report clinical measures and variability in comorbidity and concurrent pharmacotherapy due to the naturalistic nature of the study. Conclusions Results suggest that effectiveness of TMS for TRD is not differentially modified by age. Based on these naturalistic data, age alone should not be considered a contraindication or poor prognostic indicator of the antidepressant efficacy of TMS.

show abstract

Section: Introductionmentioning

confidence: 66%

Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients

Conelea

Philip

Yip

et al. 2017

Journal of Affective Disorders

View full text Add to dashboard Cite

show abstract

“…Connolly et al (2012) (19) reported data from the first 100 patients treated at their university-based TMS clinical service following FDA approval. Their cohort was also treatment resistant, with a mean of 3.4 failed adequate antidepressant trials in the current episode.…”

Section: ) Transcranial Magnetic Stimulation (Tms) For Acute Treatmementioning

confidence: 99%

The expanding evidence base for rTMS treatment of depression

George

Taylor²,

Short³

2013

Current Opinion in Psychiatry

243

160

View full text Add to dashboard Cite

Purpose of review Daily left prefrontal transcranial magnetic stimulation (TMS) for several weeks was first proposed as an acute treatment for depression in the early 1990’s, and was FDA approved in 2008. In the past year several important studies have been published that extend our understanding of this novel treatment approach. Recent findings The first round of multisite clinical trials with TMS addressed whether prefrontal rTMS has efficacy and were conducted in carefully selected depressed patients who were antidepressant medication free. Several more recent studies assess the clinical effectiveness of TMS and report that about 35–40% of real world patients who are commonly taking adjunctive antidepressants reach remission with a modest side effect profile. There are also new studies examining the durability of the TMS induced antidepressant effect. 58% of TMS remitters remain remitted at 3-month follow-up. Summary These recent studies suggest that daily left prefrontal TMS over several weeks as a treatment for depression appears to not only have efficacy in rigorous randomized controlled trials, but is effective in real world settings, with remission in 30–40% of patients. The TMS antidepressant effect, once achieved, appears to be as durable as with other antidepressant medications or interventions. Much more research is needed, particular with issues such as the TMS coil location, stimulation intensity and frequency, and dosing strategy.

show abstract

“…Since initial FDA clearance, only a few studies have examined therapeutic response in actual clinical settings using the parameters under which the treatment was approved (>3000 pulses/session, minimum of 20 sessions, goal of 120% motor threshold). One study of 85 patients from a single academic center reported response and remission rates of 50.6% and 24.7%, respectively (Connolly et al, 2012), while a multi-site, naturalistic study of 307 patients (Carpenter et al, 2012), mostly in non-academic settings, found clinician-rated response and remission rates of 58% and 37%, respectively. However, with limited data, it remains an open question as to how rTMS is faring in regular clinical practice.…”

Section: Introductionmentioning

confidence: 99%

A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression

Taylor

Bhati

Dubin

et al. 2017

Journal of Affective Disorders

View full text Add to dashboard Cite

Background Repetitive transcranial magnetic stimulation (rTMS) was approved in 2008 in the United States, and there are relatively few studies describing its use in regular clinical practice since approval. Methods From April 2011 to October 2014, ten sites within the National Network of Depression Centers (NNDC) provided data on 62 evaluable patients with a depressive episode. Treatment was determined naturalistically. Response was assessed by the Quick Inventory of Depressive Symptoms, Self-Report (QIDS-SR) as the primary outcome, and the Patient Health Questionnaire-9 (PHQ-9) and the clinician-rated Clinical Global Impression (CGI) as secondary depression measures. Results Enrolled patients exhibited significant treatment resistance, with 70.2% reporting more than 4 prior depressive episodes. Most patients received treatment with standard parameters (10 Hz over the left dorsolateral prefrontal cortex), although 22.6 % of the patients received 1 or 5 Hz stimulation at some point. Over 6 weeks of treatment, response and remission rates were 29.4% and 5.9%, respectively, for the QIDS-SR; 39.2% and 15.7%, respectively, for the PHQ-9; and 50.9% and 17.9%, respectively, for the CGI. Moderator analyses revealed no effect of prior depressive episodes, history of ECT or gender, although early life stress predicted a better response to rTMS therapy. Limitations The study was an open-label, registry trial, with relatively coarse clinical data, reflecting practice only in academic, depression-specialty centers. Because of the relatively small size and heterogeneity of the sample, type 2 errors are possible and positive findings are in need of replication. Conclusion rTMS demonstrates effectiveness in clinical practice within the NNDC, although remission rates appear slightly lower in comparison with other recent naturalistic studies.

show abstract

Effectiveness of Transcranial Magnetic Stimulation in Clinical Practice Post-FDA Approval in the United States

Abstract: Adjunctive TMS was found to be safe and effective in both acute and maintenance treatment of patients with treatment-resistant depression.

Cited by 154 publications

References 0 publications

Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients

Transcranial magnetic stimulation for treatment-resistant depression: Naturalistic treatment outcomes for younger versus older patients

The expanding evidence base for rTMS treatment of depression

A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression

Contact Info

Product

Resources

About