Impacts of rTMS on Refractory Depression and Comorbid PTSD Symptoms at a Military Treatment Facility

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Introduction</jats:title> <jats:p>Repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression has been studied for over two decades. Repetitive TMS was approved by the Food and Drug Administration in 2008 for the treatment of depression after at least one failed trial of an antidepressant medication of adequate dose and duration. This study evaluated whether rTMS treatments may be associated with measurable improvements in depression and post-traumatic stress disorder (PTSD) symptoms for treated military beneficiaries in Hawaii suffering from depression. It also examined the number of failed medication trials that patients underwent before rTMS treatment.</jats:p> </jats:sec> <jats:sec> <jats:title>Materials and Methods</jats:title> <jats:p>A retrospective chart review of 77 rTMS patients who received and completed treatment between January 1, 2010 and October 31, 2016 was performed. Under a typical treatment regimen, patients receive rTMS for 6 weeks as well as weekly psychiatric assessments, which included completion of Beck’s Depression Inventory (BDI) and PTSD Checklist (PCL). A mixed model repeated measures analysis was done assuming an autoregressive order one covariance structure to evaluate changes over time. Adjusted analyses were done to assess whether changes over time differed by age, prior diagnosis of PTSD, active duty status, and gender.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The majority of patients were from the army (74%) and 56% were on active duty. Just over half (53%) were male. Most patients (52%) had completed trials of three or more different antidepressant medications before initiation of treatment with rTMS. The mean number of antidepressant trials was 2.7. BDI and PCL scores were significantly lower at end of treatment on average compared to the pretreatment baseline scores. Mean differences for BDI and PCL were significant with P &amp;lt; 0.001 15, 30, and 45 days after TMS treatment was initiated. Overall, 44% of patients experienced a reduction ≥10 points on BDI, and 38% experienced a reduction ≥10 points on PCL. Additionally, scores fell similarly regardless of whether or not patients had a comorbid diagnosis of PTSD.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our research suggests that rTMS treatments may produce a reduction in symptoms of both depression and PTSD in patients with refractory depression and comorbid PTSD. It may be a useful alternative to antidepressants in the treatment of depression in the military population, including those with comorbid PTSD. Broader implementation of this treatment modality may prove beneficial for the purposes of military readiness, given current policies and restrictions on service members who are initiated on antidepressant medications.</jats:p> </jats:sec>

Theta burst stimulation is not inferior to high frequency repetitive transcranial magnetic stimulation in reducing symptoms of post-traumatic stress disorder in Veterans with depression: a retrospective case series

“…al., 2018), though extend this finding to a Veteran population, and to PTSD symptoms as well as depression symptoms. Our findings are also generally consistent with other recent studies from the VA showing that rTMS can improve symptoms of PTSD, though prior reports focused mostly on standard 10Hz stimulation protocols (Madore et al, 2022; Wilkes et al, 2020). Our findings, that rTMS can improve PTSD symptoms in Veterans are also consistent with those from an RCT determining the efficacy of active iTBS targeted to right-DLPFC on PTSD symptoms, as the authors found significant improvement in both PTSD and depression from the active arm of the trial at one month follow up (Philip et al, 2019).…”

“…Contrary to the findings of Yesavage et al (2018), we did not find that PTSD symptoms (as defined by both formally diagnosed and pre-treatment PCL-5 values >33) were associated with less improvement in depression scores either categorically (as defined by both formally diagnosed and pre-treatment PCL-5 values >33) or as a function of symptom scores. Rather our study participants and results are consistent with those from Hernandez et al, (2020) and Wilkes et al, (2020). In both studies, Veterans with depression and comorbid PTSD treated with rTMS experienced significant improvements in both disorders, with similar improvements in their depression symptoms compared to Veterans without PTSD.…”

Transcranial Magnetic Stimulation for Post-traumatic Stress Disorder

“…52% of patients had copleted trials of three or more antidepressants prior to treatment. Both BDI and PCL scores were significantly lower at the end of rTMS treatment when compared to the baseline scores obtained pretreatment ( 19 ). The mean differences for BDI and PCL were significant at 15, 30, and 45 days after rTMS treatment was initiated ( p < 0.001).…”

“…Wilke's et al looked at the impacts of rTMS on refractory depression and Comorbid PTSD symptoms in veterans ( 19 ). This was a retrospective chart review of 77 patients who received rTMS between January 1, 2010 and October 31, 2016.…”

“…The mean differences for BDI and PCL were significant at 15, 30, and 45 days after rTMS treatment was initiated ( p < 0.001). 44% of patients had a reduction greater than or equal to 10 points on the BDI and 38% experienced a reduction of the same amount on PCL ( 19 ).…”