Cognitive-Emotional Reactivation During Deep Transcranial Magnetic Stimulation Over the Prefrontal Cortex of Depressive Patients Affects Anti Depressant Outcome

Journal: Journal of affective disorders 128(3):235-242 (2011)

Authors: M Isserles, O Rosenberg, P Dannon, Y Levkovitz, M Kotler, F Deutsch, B Lerer, A Zangen

Background:

Transcranial magnetic stimulation (TMS) enables non-surgical activation of specific brain areas. TMS over the prefrontal cortex (PFC) is emerging as a significant tool that can augment or replace non/partially effective antidepressant medications. Deep TMS (dTMS) utilizes newly developed coils that enable effective stimulation of deeper cortical layers involved in the pathophysiology of depression.

Objective:

This study aimed to assess the H1-DTMS coil as an add-on to antidepressants in treating patients with major depression. We also intended to evaluate whether the antidepressant outcome of DTMS treatment is affected by a cognitive–emotional procedure performed during stimulation.

Methods:

57 patients were enrolled in the study that included 4 weeks of daily 20 Hz stimulation sessions and additional 4 weekly sessions as a short maintenance phase. Two subgroups of patients received either positive or negative cognitive–emotional reactivation along with the stimulation sessions.

Results:

21 of 46 patients (46%) who received at least 10 stimulation sessions achieved response (improvement of≥50% in the Hamilton Depression Rating Scale (HDRS)) and 13 of them (28%) achieved remission (HDRS-24≤10) by the end of the daily treatment phase.Improvements were smaller in the negatively reactivated group and Beck Depression Inventory scores were not significantly improved in this group.

Conclusions:

dTMS over the PFC proved to be safe and effective in augmenting anti depressant medications. Negative cognitive-emotional reactivation can disrupt the therapeutic effect of dTMS. A large sham controlled study is required to further establish the effectiveness of dTMS as an augmentation treatment and the role of cognitive reactivation during stimulation.

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