Psychostimulant use and clinical outcome of repetitive transcranial magnetic stimulation treatment of major depressive disorder

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD). Psychostimulant medication use may be associated with improved rTMS outcomes, but a detailed understanding of these relationships is lacking. Methods:We compared MDD subjects taking psychostimulants (n = 37) with those not taking one of these medications (n = 53) during a course of 30 rTMS treatments.Changes in the 30-item Inventory of Depressive Symptomatology Self Report (IDS-SR30) subscale scores were examined at treatment 30. We also subdivided subjects into three categories based on drug mechanism and looked at IDS-SR30 total score after treatments 10, 20, and 30.Results: Subjects taking psychostimulants had a significantly greater overall clinical improvement than those not taking these medications at treatment 30.The psychostimulant group also improved significantly more than the control group in "sleep" and "mood/cognition," but not "anxiety/arousal" IDS-SR30 subscales. No differences were detected among individual drug categories, which may reflect the limited sample size for individual medications. There was a negative dose-response relationship for the lisdexamfetamine/ dextroamphetamine group, in which lower doses were associated with better clinical outcome.Conclusions: Psychostimulant medications may enhance clinical efficacy of rTMS for MDD by preferentially impacting specific symptom domains. For some psychostimulants, these effects may be dose-dependent. Prospective clinical trials are needed to guide psychostimulant augmentation of brain stimulation therapies.

Repetitive transcranial magnetic stimulation in the treatment of middle-aged and elderly major depressive disorder: A randomized controlled trial

“…In this study, rTMS was administered to MDD patients on the basis of oral escitalopram tablets. The results showed a total effective rate of 95.0%, similar to the study by Wilke et al, [ 15 ] indicating that rTMS can further improve the efficacy and alleviate symptoms in the treatment of MDD patients. RTMS is a type of physical therapy that was first proposed in 1985 and found to stimulate both the brain and nerves.…”

“…Functional areas such as the prefrontal cortex and subcortical cingulate gyrus are closely related to human emotional management and are common functional disorders in patients with depression. [ 15 , 16 ] Transcranial magnetic stimulation therapy can stimulate this area, activate specific neural circuit activities, and achieve the effect of regulating the emotional state of the brain and improving the emotional status of patients. [ 16 , 17 ] In addition, a large number of animal model studies in recent years have shown that rTMS is similar to antidepressants in the treatment of depression, and can promote the formation of hippocampal neurons.…”

A Review of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation Combined with Medication and Psychotherapy for Depression

“…The final set of sixteen studies (half open-label and half randomized controlled trials) investigated administering TMS in conjunction with stable doses of ongoing medications. Seven out the eight randomized controlled trials found that adding TMS on top of stable ongoing medications can reduce MDD symptoms 47-53 . One study found comparable reductions between the active and control groups 54 .…”

“…Seven out the eight randomized controlled trials found that adding TMS on top of stable ongoing medications can reduce MDD symptoms. [47][48][49][50][51][52][53] One study found comparable reductions between the active and control groups. 54 The eight open-label studies found MDD symptom reductions of 15.4% to 63.3%, with an average of 50.8%.…”

rTMS in mental health disorders

“…Interestingly, smaller doses of lisdexamfetamine/dextroamphetamine correlated with better rTMS outcomes. Despite promising results, the authors cautioned that the study's small sample size, limited data on psychostimulant use duration, and the lack of causal evidence necessitate further trials for solidifying the safety and efficacy of combining psychostimulants with rTMS (Wilke et al, 2022).…”