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

Stephan F. Taylor, Mahendra T. Bhati, Marc J. Dubin, John M. Hawkins, Sarah H. Lisanby, Oscar Morales, Irving M. Reti, Shirlene Sampson, E. Baron Short, Catherine Spino, Kuanwong Watcharotone, Jesse Wright

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)284-290
Number of pages7
JournalJournal of Affective Disorders
Volume208
DOIs
StatePublished - Jan 15 2017

Fingerprint

Magnetic Field Therapy
Transcranial Magnetic Stimulation
Depression
Self Report
Equipment and Supplies
Health
Therapeutics
Prefrontal Cortex
Psychological Stress
Sample Size
Registries

Keywords

  • Brain
  • Dorsolateral prefrontal cortex
  • Neuromodulation
  • Registry

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Taylor, S. F., Bhati, M. T., Dubin, M. J., Hawkins, J. M., Lisanby, S. H., Morales, O., ... Wright, J. (2017). A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression. Journal of Affective Disorders, 208, 284-290. https://doi.org/10.1016/j.jad.2016.08.049

A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression. / Taylor, Stephan F.; Bhati, Mahendra T.; Dubin, Marc J.; Hawkins, John M.; Lisanby, Sarah H.; Morales, Oscar; Reti, Irving M.; Sampson, Shirlene; Short, E. Baron; Spino, Catherine; Watcharotone, Kuanwong; Wright, Jesse.

In: Journal of Affective Disorders, Vol. 208, 15.01.2017, p. 284-290.

Research output: Contribution to journalArticle

Taylor, SF, Bhati, MT, Dubin, MJ, Hawkins, JM, Lisanby, SH, Morales, O, Reti, IM, Sampson, S, Short, EB, Spino, C, Watcharotone, K & Wright, J 2017, 'A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression', Journal of Affective Disorders, vol. 208, pp. 284-290. https://doi.org/10.1016/j.jad.2016.08.049
Taylor, Stephan F. ; Bhati, Mahendra T. ; Dubin, Marc J. ; Hawkins, John M. ; Lisanby, Sarah H. ; Morales, Oscar ; Reti, Irving M. ; Sampson, Shirlene ; Short, E. Baron ; Spino, Catherine ; Watcharotone, Kuanwong ; Wright, Jesse. / A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression. In: Journal of Affective Disorders. 2017 ; Vol. 208. pp. 284-290.
@article{f766b71ade014b46a02da1faa025e8c9,
title = "A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression",
abstract = "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.",
keywords = "Brain, Dorsolateral prefrontal cortex, Neuromodulation, Registry",
author = "Taylor, {Stephan F.} and Bhati, {Mahendra T.} and Dubin, {Marc J.} and Hawkins, {John M.} and Lisanby, {Sarah H.} and Oscar Morales and Reti, {Irving M.} and Shirlene Sampson and Short, {E. Baron} and Catherine Spino and Kuanwong Watcharotone and Jesse Wright",
year = "2017",
month = "1",
day = "15",
doi = "10.1016/j.jad.2016.08.049",
language = "English (US)",
volume = "208",
pages = "284--290",
journal = "Journal of Affective Disorders",
issn = "0165-0327",
publisher = "Elsevier",

}

TY - JOUR

T1 - A naturalistic, multi-site study of repetitive transcranial magnetic stimulation therapy for depression

AU - Taylor, Stephan F.

AU - Bhati, Mahendra T.

AU - Dubin, Marc J.

AU - Hawkins, John M.

AU - Lisanby, Sarah H.

AU - Morales, Oscar

AU - Reti, Irving M.

AU - Sampson, Shirlene

AU - Short, E. Baron

AU - Spino, Catherine

AU - Watcharotone, Kuanwong

AU - Wright, Jesse

PY - 2017/1/15

Y1 - 2017/1/15

N2 - 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.

AB - 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.

KW - Brain

KW - Dorsolateral prefrontal cortex

KW - Neuromodulation

KW - Registry

UR - http://www.scopus.com/inward/record.url?scp=84994035356&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994035356&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2016.08.049

DO - 10.1016/j.jad.2016.08.049

M3 - Article

C2 - 27794252

AN - SCOPUS:84994035356

VL - 208

SP - 284

EP - 290

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -