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Brain Stimul. 2015 Mar-Apr;8(2):208-15. doi: 10.1016/j.brs.2014.11.002. Epub 2014 Nov 6.

rTMS of the dorsomedial prefrontal cortex for major depression: safety, tolerability, effectiveness, and outcome predictors for 10 Hz versus intermittent theta-burst stimulation.

Author information

1
MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, 399 Bathurst Street, Room 7M-415, Toronto, Ontario, Canada M5T 2S8; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada M5S 1A8.
2
MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, 399 Bathurst Street, Room 7M-415, Toronto, Ontario, Canada M5T 2S8; Faculty of Arts and Sciences, University of Toronto, 100 St. George Street, Toronto, Ontario, Canada M5S 3G3.
3
MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, 399 Bathurst Street, Room 7M-415, Toronto, Ontario, Canada M5T 2S8; Department of Psychiatry, University of Toronto, 250 College Street, Floor 8, Toronto, Ontario, Canada M5T 1R8.
4
Department of Psychiatry, University of Toronto, 250 College Street, Floor 8, Toronto, Ontario, Canada M5T 1R8; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada M5S 1A8; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
5
Department of Psychiatry, University of Toronto, 250 College Street, Floor 8, Toronto, Ontario, Canada M5T 1R8; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada M5S 1A8.
6
MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, 399 Bathurst Street, Room 7M-415, Toronto, Ontario, Canada M5T 2S8; Department of Psychiatry, University of Toronto, 250 College Street, Floor 8, Toronto, Ontario, Canada M5T 1R8; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada M5S 1A8; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Electronic address: jonathan.downar@uhn.ca.

Abstract

BACKGROUND:

Conventional rTMS protocols for major depression commonly employ stimulation sessions lasting >30 min. However, recent studies have sought to improve costs, capacities, and outcomes by employing briefer protocols such as theta burst stimulation (iTBS).

OBJECTIVE:

To compare safety, effectiveness, and outcome predictors for DMPFC-rTMS with 10 Hz (30 min) versus iTBS (6 min) protocols, in a large, naturalistic, retrospective case series.

METHODS:

A chart review identified 185 patients with a medication-resistant major depressive episode who underwent 20-30 sessions of DMPFC-rTMS (10 Hz, n = 98; iTBS, n = 87) at a single Canadian clinic from 2011 to 2014.

RESULTS:

Clinical characteristics of 10 Hz and iTBS patients did not differ prior to treatment, aside from significantly higher age in iTBS patients. A total 7912 runs of DMPFC-rTMS (10 Hz, 4274; iTBS, 3638) were administered, without any seizures or other serious adverse events, and no significant differences in rates of premature discontinuation between groups. Dichotomous outcomes did not differ significantly between groups (Response/remission rates: Beck Depression Inventory-II: 10 Hz, 40.6%/29.2%; iTBS, 43.0%/31.0%. 17-item Hamilton Rating Scale for Depression: 10 Hz, 50.6%/38.5%; iTBS, 48.5%/27.9%). On continuous outcomes, there was no significant difference between groups in pre-treatment or post-treatment scores, or percent improvement on either measure. Mixed-effects modeling revealed no significant group-by-time interaction on either measure.

CONCLUSIONS:

Both 10 Hz and iTBS DMPFC-rTMS appear safe and tolerable at 120% resting motor threshold. The effectiveness of 6 min iTBS and 30 min 10 Hz protocols appears comparable. Randomized trials comparing 10 Hz to iTBS may be warranted.

KEYWORDS:

Bipolar; Case series; Chart review; Depression; Dorsomedial; Predictor; Theta burst stimulation; rTMS

PMID:
25465290
DOI:
10.1016/j.brs.2014.11.002
[Indexed for MEDLINE]
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