Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression Relation between Efficacy and Stimulation Intensity

Padberg, Frank; Zwanzger, Peter; Keck, Martin E.; Kathmann, Norbert; Mikhaiel, P.; Ella, Robin; Rupprecht, Philipp; Thoma, Heike; Hampel, Harald; Toschi, Nicola; Möller, Hans‐Jürgen

doi:10.1016/s0893-133x(02)00338-x

Cited by 96 publications

(83 citation statements)

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“…Treatment-related factors influencing antidepressant response with TMS include stimulation intensity, frequency, number of pulses administered, and duration of the treatment course (Gershon et al, 2003;Padberg et al, 2002;Sachdev et al, 2002). Increasing the distance from the coil to the target cortex decreases the intensity of the stimulation reaching the brain, which is negatively correlated with antidepressant response and with the degree of stimulation-induced brain activation (Kozel et al, 2000;Mosimann et al, 2002;Nahas et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: Clinical Predictors of Outcome in a Multisite, Randomized Controlled Clinical Trial

Lisanby

Husain

Rosenquist

et al. 2008

Neuropsychopharmacol

291

175

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Randomized controlled trials support the antidepressant efficacy of transcranial magnetic stimulation (TMS); however, there is individual variability in the magnitude of response. Examination of response predictors has been hampered by methodological limitations such as small sample sizes and single-site study designs. Data from a multisite sham-controlled trial of the antidepressant efficacy of TMS provided an opportunity to examine predictors of acute outcome. An open-label extension for patients who failed to improve provided the opportunity for confirmatory analysis. Treatment was administered to the left dorsolateral prefrontal cortex at 10 pulses per second, 120% of motor threshold, for a total of 3000 pulses per day. Change on the Montgomery-Asberg Depression Rating Scale after 4 weeks was the primary efficacy outcome. A total of 301 patients with nonpsychotic unipolar major depression at 23 centers were randomized to active or sham TMS. Univariate predictor analyses showed that the degree of prior treatment resistance in the current episode was a predictor of positive treatment outcome in both the controlled study and the open-label extension trial. In the randomized trial, shorter duration of current episode was also associated with a better outcome. In the open-label extension study, absence of anxiety disorder comorbidity was associated with an improved outcome, but duration of current episode was not. The number of prior treatment failures was the strongest predictor for positive response to acute treatment with TMS. Shorter duration of current illness and lack of anxiety comorbidity may also confer an increased likelihood of good antidepressant response to TMS.

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Section: Introductionmentioning

confidence: 99%

Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: Clinical Predictors of Outcome in a Multisite, Randomized Controlled Clinical Trial

Lisanby

Husain

Rosenquist

et al. 2008

Neuropsychopharmacol

291

175

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“…There is some evidence showing that motor threshold (MT) stimulation produces stronger antidepressant effect than subthreshold stimulation (Padberg et al 2002). There is an anecdotal report from two subjects implying that the prefrontal cortex may react differently to TMS than the motor cortex when other than threshold stimulus intensities are applied ).…”

Section: Introductionmentioning

confidence: 99%

Prefrontal TMS produces smaller EEG responses than motor-cortex TMS: implications for rTMS treatment in depression

et al. 2005

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“…Extended treatment with repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to ameliorate symptoms in major depression throughout the majority of controlled clinical trials Berman et al 2000;George et al 2000;Padberg et al 2002b). Moreover, several lines of evidence based on behavioral animal models as well as neurochemical findings support the notion that rTMS exerts an antidepressant-like action (Fleischmann et al 1995;Zyss et al 1997;Ben-Shachar et al 1999;Kole et al 1999;Keck et al 2000).…”

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confidence: 99%

Plasma Concentrations of Neuroactive Steroids before and after Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression

Padberg

Michele

Zwanzger

et al. 2002

Neuropsychopharmacology

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151

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There is evidence for altered levels of neuroactive steroids in major depression that normalize after successful antidepressant pharmacotherapy. Currently it is not known whether this is a general principle of clinically effective antidepressant therapy or a pharmacological effect of antidepressants. Here, we investigated whether repetitive transcranial magnetic stimulation (rTMS) may affect plasma concentrations of neuroactive steroids in a similarway as antidepressant pharmacotherapy. Progesterone, 3 ␣ ,, 3 ␣ ,, 3 ␤ , NO . 5 Neuroactive Steroids before and after rTMS 875 action (Fleischmann et al. 1995;Zyss et al. 1997;Ben-Shachar et al. 1999;Kole et al. 1999;Keck et al. 2000). Neuroactive steroids interacting with the ␥ -aminobutyric acid type A (GABA A ) benzodiazepine receptor complex have been suggested to be involved in the pathophysiology of major depression and the action of antidepressant pharmacotherapy (George et al. 1994;Romeo et al. 1998;Uzunova et al. 1998;Rupprecht and Holsboer 1999;Rupprecht et al. 2001). Lowered levels of 3 ␣ -reduced neuroactive steroids have been found in plasma and cerebrospinal fluid (CSF) of depressed patients (Romeo et al. 1998;Uzunova et al. 1998), which normalized following successful treatment with fluoxetine (Romeo et al. 1998;Uzunova et al. 1998) and other antidepressant drugs (Romeo et al. 1998). On the other hand, dehydroepiandrosterone (DHEA) has been shown to exert beneficial effects on depressive symptoms in a placebo-controlled study (Wolkowitz et al. 1999). In rodents, 3 ␣ -reduced neuroactive steroids and dehydroepiandrosterone sulfate (DHEAS) have been found to exert antidepressant-like effects in the forced swim test Urani et al. 2001). In addition, the formation of 3 ␣ -reduced neuroactive steroids is enhanced by treatment with selective serotonin reuptake inhibitors (SSRI) (Uzunov et al. 1996;Griffin and Mellon 1999). Currently it is not known whether the normalization of altered neuroactive steroid concentrations is a prerequisite for the alleviation of depressive symptoms or due to a specific pharmacological action of antidepressant drugs. In the present study we therefore investigated whether repetitive transcranial magnetic stimulation (rTMS) as a novel non-pharmacological treatment in major depression affects plasma concentrations of neuroactive steroids. METHODSThirty-seven inpatients were included in an open-label protocol (age: 51.5 Ϯ 14.8 years, 23 women, 14 men). Patients met DSM-IV criteria for a major depressive episode. All patients gave their written informed consent for this study after the procedure had been fully explained. The study was approved by the local ethical committee. Prior to the study, antidepressant medication and benzodiazepines were washed out for at least seven days and patients remained medication-free during the entire study.Repetitive transcranial magnetic stimulation was applied as reported elsewhere (Padberg et al. 2002a). Patients underwent 10 sessions of rTMS (10 Hz, 15 trains of 10 s each, 30 s inter-train in...

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Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression Relation between Efficacy and Stimulation Intensity

Cited by 96 publications

References 32 publications

Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: Clinical Predictors of Outcome in a Multisite, Randomized Controlled Clinical Trial

Daily Left Prefrontal Repetitive Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: Clinical Predictors of Outcome in a Multisite, Randomized Controlled Clinical Trial

Prefrontal TMS produces smaller EEG responses than motor-cortex TMS: implications for rTMS treatment in depression

Plasma Concentrations of Neuroactive Steroids before and after Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression

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