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Strategies for Augmentation of High-Frequency Left-sided Repetitive Transcranial Magnetic Stimulation Treatment of Major Depressive Disorder

Lee, Jonathan C. and Wilson, Andrew C. and Corlier, Juliana and Tadayonnejad, Reza and Marder, Katharine G. and Pleman, Christopher M. and Krantz, David E. and Wilke, Scott A. and Levitt, Jennifer G. and Ginder, Nathaniel D. and Leuchter, Andrew F. (2020) Strategies for Augmentation of High-Frequency Left-sided Repetitive Transcranial Magnetic Stimulation Treatment of Major Depressive Disorder. Journal of Affective Disorders, 277 . pp. 964-969. ISSN 0165-0327. https://resolver.caltech.edu/CaltechAUTHORS:20200916-073859148

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Abstract

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is an effective intervention for treatment-resistant Major Depressive Disorder (MDD). Early improvement during high-frequency left-sided (HFL) stimulation of the dorsolateral prefrontal cortex (DLPFC) is an important predictor of longer-term outcome, but most patients benefit later in their treatment course. We examined patients without early improvement with HFL to determine whether augmentation with additional stimulation approaches improved treatment outcome. Methods: 139 participants received HFL in a measurement-based care paradigm. Participants who achieved < 20% improvement by treatment 10 could continue with HFL (N=17) or receive one of two augmentation strategies: bilateral stimulation (BL; HFL followed by low-frequency stimulation of right DLPFC) (N=69) or intermittent theta-burst priming of left DLPFC (iTBS-P) (N=17) for their remaining treatment sessions. The primary outcome was the percent reduction in depressive symptoms at treatment 30. Results: Participants who achieved < 20% improvement by treatment 10 and continued with HFL showed limited benefit. iTBS-P participants had significantly greater improvement, while those receiving BL trended toward improved outcomes. Ten sessions of either augmentation strategy appeared necessary to determine the likelihood of benefit. Conclusions: Augmentation of early non-response to HFL appears to improve rTMS outcomes, with a novel iTBS-P strategy surpassing both continued HFL or BL treatment in participants with < 20% improvement after 10 treatments. These findings suggest that measurement-based care with addition of augmented stimulation for those not showing early improvement may yield superior rTMS treatment outcomes.


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.1016/j.jad.2020.09.011DOIArticle
ORCID:
AuthorORCID
Lee, Jonathan C.0000-0003-3934-6458
Additional Information:© 2020 Elsevier B.V. Received 16 June 2020, Revised 24 August 2020, Accepted 2 September 2020, Available online 8 September 2020. The authors would like to acknowledge the patients and their families who received treatment in the clinic during the study period, and the dedication of the technicians and administrative team that have made this work possible. This project was made possible by the Ryan Family Fund for TMS Research. We thank the Ryan Family for their generous support of innovative approaches to depression treatment and of groundbreaking TMS technology. Their contributions have advanced the university's education and research missions through support of a postdoctoral scholar in the Neuromodulation Division. Author statement contributors: JCL – conceptualization, design, data curation, interpretation, drafting, revising manuscript, final approval; ACW – conceptualization, design, data curation, data analysis, interpretation, drafting, revising manuscript, final approval; JC – conceptualization, design, data curation, data analysis, interpretation, figures, drafting, revising manuscript, final approval; RT - conceptualization, design, data curation, data analysis, interpretation, figures, drafting, revising manuscript, final approval; KGM – data curation, interpretation, drafting, revising manuscript, final approval; CMP – data curation, interpretation, drafting, revising manuscript, final approval; DEK – interpretation, revising manuscript, final approval; SAW – data curation, interpretation, drafting, revising manuscript, final approval; JGL – data curation, interpretation, drafting, revising manuscript, final approval; NDG – data curation, interpretation, drafting, revising manuscript, final approval; AFL - conceptualization, design, data curation, data analysis, interpretation, figures, drafting, revising manuscript, final approval. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Competing Interest: Jonathan Lee has received in-kind equipment support from Magventure Inc. Andrew Wilson has served as a consultant to HeartCloud, Inc. within the past 36 months. Juliana Corlier has no disclosures to report. Reza Tadayon-Nejad has no disclosures to report. Katharine Marder has no disclosures to report. Christopher Pleman has no disclosures to report. David Krantz has no disclosures to report. Scott Wilke has no disclosures to report. Jennifer Levitt has no disclosures to report. Nathaniel Ginder has no disclosures to report. Dr. Leuchter discloses that within the past 36 months he has received research support from the National Institutes of Health, Neuronetics, Department of Defense, CHDI Foundation, and NeuroSigma, Inc. He has served as a consultant to NeoSync, Inc., Ionis Pharmaceuticals, Inc., and ElMindA. He is Chief Scientific Officer of Brain Biomarker Analytics LLC (BBA). Dr. Leuchter owns stock options in NeoSync, Inc. and has equity interest in BBA.
Funders:
Funding AgencyGrant Number
Ryan Family Fund for TMS ResearchUNSPECIFIED
Subject Keywords:Repetitive transcranial magnetic stimulation (rTMS); treatment outcome; major depressive disorder (MDD); theta burst stimulation; bilateral rTMS; treatment augmentation
Record Number:CaltechAUTHORS:20200916-073859148
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20200916-073859148
Official Citation:Jonathan C. Lee, Andrew C. Wilson, Juliana Corlier, Reza Tadayonnejad, Katharine G. Marder, Christopher M. Pleman, David E. Krantz, Scott A. Wilke, Jennifer G. Levitt, Nathaniel D. Ginder, Andrew F. Leuchter, Strategies for augmentation of high-frequency left-sided repetitive transcranial magnetic stimulation treatment of major depressive disorder, Journal of Affective Disorders, Volume 277, 2020, Pages 964-969, ISSN 0165-0327, https://doi.org/10.1016/j.jad.2020.09.011. (http://www.sciencedirect.com/science/article/pii/S0165032720327063)
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:105396
Collection:CaltechAUTHORS
Deposited By: Tony Diaz
Deposited On:16 Sep 2020 15:40
Last Modified:30 Sep 2020 20:35

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