Purpose of the study: Over the last years Transcranial Magnetic Stimulation (TMS) has been investigated to study motor pathways and motor cortical excitability in healthy subjects and in patients with neurological disorders. Several clinical studies have been focussed on the efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of Resistant Major Depression which is also the psychiatric field where rTMS has received more indications and approvals worldwide. In the treatment of pharmaco-resistant major depression, interventions strategy include combination of antidepressant drugs with different mechanisms of action and augmentation of somatic treatments to pharmacological therapy. In this regard, the use of rTMS as add-on treatment truly represents one of the major foci in clinical research. Objectives: Object of this study was to evaluate the long-term effect on depressive symptoms and frontal lobe abilities of rTMS as add-on therapy in the treatment of drugs resistant major depression [1]. Methods: A sample of fifteen drug resistant depressed outpatients meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for nonpsychotic major depressive disorder were assigned to receive fifteen sessions of high frequency rTMS stimulation of the left dorsolateral prefrontal cortex. Active rTMS was performed five days per week for four weeks consecutively. Each session of rTMS was delivered as follows: 10 Hz, four-second-train duration, a 26-second inter-train interval, for a total of 3000 pulses per session lasting 37.5 minutes. The intensity of the magnetic stimulus was set at 120% of the resting motor threshold. During the course of rTMS, the patients were taking their medication which included Selective Serotonin Reuptake Inhibitors (SSRI), Tricyclic Antidepressant and Atypical Antipsychotic Drugs. Their doses were required to remain stable in the four weeks preceding the trial and for its entire duration. Patients were followed up for six months to determine the long-term effect of rTMS as add-on therapy. Outcome measures for the evaluation of depressive symptoms consisted of Hamilton Depression Rating Scale 21-item (HAM-D) and the Montgomery Asberg Depression Rating Scale (MADRS). A neuropsychological battery for the evaluation of different frontal lobe abilities included the Frontal Assessment Battery and the Stroop Color Word Test interference. Effectiveness data was gathered at baseline (T0), at the end of treatment (T1) and 6 months after the end of treatment (T2) [2]. Results: Results from the present study showed statistically significant mood improvements as indexed by a reduction of more than 40% on the Hamilton Rating Scale for Depression and on Montgomery Asberg Depression Rating Scale at the end of treatment and six months after treatment. Frontal Assessment Battery and the Stroop Color Word Test interference outcome scores didn’t significantly differ at treatment end and after six months. Conclusion: Our findings demonstrate the antidepressant effect of adjunctive Repetitive Transcranial Magnetic Stimulation treatment. Moreover this study confirms good tolerability of rTMS and the maintenance of the antidepressant effect six months after the treatment, as shown by a decrease in HAM-D and MADRS [3].

P.4.027 Six-month follow-up study of repetitive transcranial magnetic stimulation in the treatment of resistant major depressive disorder

Concerto C
Primo
;
Cannavò D
Secondo
;
Magnano San Lio F;Ricceri R;Lanza G
Penultimo
;
Aguglia E
Ultimo
2013

Abstract

Purpose of the study: Over the last years Transcranial Magnetic Stimulation (TMS) has been investigated to study motor pathways and motor cortical excitability in healthy subjects and in patients with neurological disorders. Several clinical studies have been focussed on the efficacy of Repetitive Transcranial Magnetic Stimulation (rTMS) in the treatment of Resistant Major Depression which is also the psychiatric field where rTMS has received more indications and approvals worldwide. In the treatment of pharmaco-resistant major depression, interventions strategy include combination of antidepressant drugs with different mechanisms of action and augmentation of somatic treatments to pharmacological therapy. In this regard, the use of rTMS as add-on treatment truly represents one of the major foci in clinical research. Objectives: Object of this study was to evaluate the long-term effect on depressive symptoms and frontal lobe abilities of rTMS as add-on therapy in the treatment of drugs resistant major depression [1]. Methods: A sample of fifteen drug resistant depressed outpatients meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for nonpsychotic major depressive disorder were assigned to receive fifteen sessions of high frequency rTMS stimulation of the left dorsolateral prefrontal cortex. Active rTMS was performed five days per week for four weeks consecutively. Each session of rTMS was delivered as follows: 10 Hz, four-second-train duration, a 26-second inter-train interval, for a total of 3000 pulses per session lasting 37.5 minutes. The intensity of the magnetic stimulus was set at 120% of the resting motor threshold. During the course of rTMS, the patients were taking their medication which included Selective Serotonin Reuptake Inhibitors (SSRI), Tricyclic Antidepressant and Atypical Antipsychotic Drugs. Their doses were required to remain stable in the four weeks preceding the trial and for its entire duration. Patients were followed up for six months to determine the long-term effect of rTMS as add-on therapy. Outcome measures for the evaluation of depressive symptoms consisted of Hamilton Depression Rating Scale 21-item (HAM-D) and the Montgomery Asberg Depression Rating Scale (MADRS). A neuropsychological battery for the evaluation of different frontal lobe abilities included the Frontal Assessment Battery and the Stroop Color Word Test interference. Effectiveness data was gathered at baseline (T0), at the end of treatment (T1) and 6 months after the end of treatment (T2) [2]. Results: Results from the present study showed statistically significant mood improvements as indexed by a reduction of more than 40% on the Hamilton Rating Scale for Depression and on Montgomery Asberg Depression Rating Scale at the end of treatment and six months after treatment. Frontal Assessment Battery and the Stroop Color Word Test interference outcome scores didn’t significantly differ at treatment end and after six months. Conclusion: Our findings demonstrate the antidepressant effect of adjunctive Repetitive Transcranial Magnetic Stimulation treatment. Moreover this study confirms good tolerability of rTMS and the maintenance of the antidepressant effect six months after the treatment, as shown by a decrease in HAM-D and MADRS [3].
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/372374
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