Efficacy of Deep TMS with the H1 Coil for Anxious Depression

Abstract

(1) Background: While the therapeutic efficacy of Transcranial Magnetic Stimulation (TMS) for major depressive disorder (MDD) is well established, less is known about the technique’s efficacy for treating comorbid anxiety. (2) Methods: Data were retrospectively analyzed from randomized controlled trials (RCTs) that used Deep TMS with the H1 Coil for MDD treatment. The primary endpoint was the difference relative to sham treatment following 4 weeks of stimulation. The effect size was compared to literature values for superficial TMS and medication treatments. (3) Results: In the pivotal RCT, active Deep TMS compared with sham treatment showed significantly larger improvements in anxiety score (effect size = 0.34, p = 0.03 (FDR)) which were sustained until 16 weeks (effect size = 0.35, p = 0.04). The pooled effect size between all the RCTs was 0.55, which compares favorably to alternative treatments. A direct comparison to Figure-8 Coil treatment indicated that treatment with the H1 Coil was significantly more effective (p = 0.042). In contrast to previously reported studies using superficial TMS and medication for which anxiety has been shown to be a negative predictor of effectiveness, higher baseline anxiety was found to be predictive of successful outcome for the H1-Coil treatment. (4) Conclusions: Deep TMS is effective in treating comorbid anxiety in MDD and, unlike alternative treatments, the outcome does not appear to be adversely affected by high baseline anxiety levels.

Pursuing personalized medicine for depression by targeting the lateral or medial prefrontal cortex with Deep TMS

“…To explore this, we analyzed the relation between baseline (pretreatment) symptom cluster severity and response to 1 H-coil (brain target) over the other. Informed by recent evidence of the H1 coil’s polysymptomatic effect on depression and anxiety symptoms ( 11 , 37 , 38 ), we used a baseline cluster consisting of 8 depression and anxiety HDRS-21 items (items 1, 7–11, 13, and 15) established in the literature through factor analysis ( 43 ), which underwent leave one feature out (LOFO) optimization to include 3 depression-related items (1, depressed mood; 7, work and interests; 8, retardation) and 3 anxiety-related items (9, agitation; 10, anxiety psychic; 11, anxiety somatic), as detailed in Supplemental Data 2 , “Correlation between C-DEPTH and percent change in HDRS-21 score.”…”

“…Next, absolute activity power in the alpha (8-12 Hz) and low-gamma (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) bands was extracted, and asymmetric activity scores were calculated as ratio between activity power of each electrode and that of the homologous electrode in the counter hemisphere. Alpha, low-gamma, and low-gamma/alpha ratio of activity and asymmetry scores were then linearly correlated with improvement percentage in HDRS21 score following 6 weeks of treatment.…”

“…Optimally, C-DEPTH would be based on symptom clusters at baseline, and would provide clinicians a straightforward method for differentiating between patients who are likely to respond to one stimulation target over the other. Here, exploration for such a clinical marker was informed by recent evidence of the H1 Coil's polysymptomatic effect on depression and anxiety symptoms (11,23,(38)(39)(40)(41)(42). We hypothesized that patients showing high baseline scores in core symptoms of both depression and anxiety, will respond better to the H1 coil.…”

Effects of Repetitive Transcranial Magnetic Stimulation to the Dorsolateral Prefrontal Cortex on Withdrawal and State Anxiety in People Who Smoke Cigarettes

“…Similarly, another device (H1 coil) from the same company with a different neural target has been approved specifically to treat anxiety that is comorbid with depression (Pell et al, 2022). These recently-approved deep TMS devices differ from conventional figure-eight TMS coils in the shape and depth of the electric field that they produce, and future work should compare their efficacy to conventional TMS devices for smoking cessation.…”

Neurophysiology Involved in Neuroplasticity: Mechanisms of Forgetting

“…Depressive or anxious patients could be treated with Transcranial Magnetic Stimulation (TMS) to diminish the symptoms [65,66]. Also, it is possible for future protocols to evaluate forgetfulness.…”