TY - JOUR
T1 - Efficacy, tolerability, and cognitive effects of deep transcranial magnetic stimulation for late-life depression
T2 - a prospective randomized controlled trial
AU - Kaster, Tyler S.
AU - Daskalakis, Zafiris J.
AU - Noda, Yoshihiro
AU - Knyahnytska, Yuliya
AU - Downar, Jonathan
AU - Rajji, Tarek K.
AU - Levkovitz, Yechiel
AU - Zangen, Abraham
AU - Butters, Meryl A.
AU - Mulsant, Benoit H.
AU - Blumberger, Daniel M.
N1 - Funding Information:
We thank Marcos Sanches for his assistance with the statistical analysis. This study was supported by the Canadian Institute for Health Research University-Industry Sponsored Operating Grant in conjunction with Brainsway Ltd. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The authors attest that they had full access to all the data in the study and had final responsibility for the decision to submit the publication.
Publisher Copyright:
© 2018, American College of Neuropsychopharmacology.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Late-life depression (LLD) is a growing worldwide problem due to demographic changes, with limited treatment options due to high rates of pharmacotherapy adverse effects, accessibility of psychotherapy, and tolerability of electroconvulsive therapy. Novel neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), may overcome these limitations. The objective of this study is to determine the efficacy, tolerability, and cognitive effects of high-dose deep rTMS in LLD. In this study we randomized older adults between 60 and 85 years old with major depressive disorder (MDD) to sham or active deep rTMS (H1 coil, 6012 pulses, 18 Hz, 120% of resting motor threshold) delivered over the dorsolateral and ventrolateral prefrontal cortex 5 days per week over 4 weeks. Our primary outcome was remission of depression in an intention-to-treat analysis. We also assessed change in cognitive functioning with rTMS treatment and tolerability based on adverse effects. Fifty-two participants were randomized to active (n = 25) or sham H1 coil (n = 27). Remission rate was significantly higher with active than sham rTMS (40.0% vs 14.8%) with a number needed to treat of 4.0 (95% CI: 2.1–56.5). There was no change on any measure of executive function and no serious adverse events. Adverse effect profiles were similar between active and sham rTMS, except for reports of pain being significantly more common in the active condition (16.0% vs 0%). High-dose deep rTMS appears to be safe, well tolerated, and efficacious in the treatment of LLD.
AB - Late-life depression (LLD) is a growing worldwide problem due to demographic changes, with limited treatment options due to high rates of pharmacotherapy adverse effects, accessibility of psychotherapy, and tolerability of electroconvulsive therapy. Novel neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), may overcome these limitations. The objective of this study is to determine the efficacy, tolerability, and cognitive effects of high-dose deep rTMS in LLD. In this study we randomized older adults between 60 and 85 years old with major depressive disorder (MDD) to sham or active deep rTMS (H1 coil, 6012 pulses, 18 Hz, 120% of resting motor threshold) delivered over the dorsolateral and ventrolateral prefrontal cortex 5 days per week over 4 weeks. Our primary outcome was remission of depression in an intention-to-treat analysis. We also assessed change in cognitive functioning with rTMS treatment and tolerability based on adverse effects. Fifty-two participants were randomized to active (n = 25) or sham H1 coil (n = 27). Remission rate was significantly higher with active than sham rTMS (40.0% vs 14.8%) with a number needed to treat of 4.0 (95% CI: 2.1–56.5). There was no change on any measure of executive function and no serious adverse events. Adverse effect profiles were similar between active and sham rTMS, except for reports of pain being significantly more common in the active condition (16.0% vs 0%). High-dose deep rTMS appears to be safe, well tolerated, and efficacious in the treatment of LLD.
UR - http://www.scopus.com/inward/record.url?scp=85049067048&partnerID=8YFLogxK
U2 - 10.1038/s41386-018-0121-x
DO - 10.1038/s41386-018-0121-x
M3 - Article
AN - SCOPUS:85049067048
SN - 0893-133X
VL - 43
SP - 2231
EP - 2238
JO - Neuropsychopharmacology
JF - Neuropsychopharmacology
IS - 11
ER -
