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Treatment of patients with geriatric depression with repetitive transcranial magnetic stimulation.

ABSTRACT: Repetitive transcranial magnetic stimulation (rTMS) has become a useful tool to treat different neuropsychiatric conditions such as depression, dementia and extrapyramidal syndromes insufficiently responding to conventional treatment. In this SHAM-controlled exploratory study safety, symptom improvement as well as changes in inflammation markers and neurotransmitter precursor amino acids availability were studied after a prefrontal cortex (PFC) stimulation using rTMS as add-on treatment in 29 patients with geriatric depression. Out of these, ten patients received SHAM treatment. Treatment was well tolerated, no serious adverse effects were observed. A clear improvement in symptoms of depression with a significant decrease in the HAMD-7 (U?=?3.306, p?=?0.001) was found by rTMS treatment. In parallel, serum phenylalanine dropped significantly (U?=?2.340, p?

SUBMITTER: Leblhuber F

PROVIDER: S-EPMC6647391 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Treatment of patients with geriatric depression with repetitive transcranial magnetic stimulation.

Leblhuber F F Steiner K K Fuchs Dietmar D

Journal of neural transmission (Vienna, Austria : 1996) 20190627 8

Repetitive transcranial magnetic stimulation (rTMS) has become a useful tool to treat different neuropsychiatric conditions such as depression, dementia and extrapyramidal syndromes insufficiently responding to conventional treatment. In this SHAM-controlled exploratory study safety, symptom improvement as well as changes in inflammation markers and neurotransmitter precursor amino acids availability were studied after a prefrontal cortex (PFC) stimulation using rTMS as add-on treatment in 29 pa ...[more]

PMID: 31250285

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| S-EPMC6449763 | biostudies-literature

Repetitive transcranial magnetic stimulation treatment for peripartum depression: systematic review & meta-analysis.

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Project description: Not available

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Segregation of salience network predicts treatment response of depression to repetitive transcranial magnetic stimulation.

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| S-EPMC6378906 | biostudies-literature

No change in neuropsychological functioning after receiving repetitive transcranial magnetic stimulation treatment for major depression.

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Project description:OBJECTIVES:Repetitive transcranial magnetic stimulation (rTMS) seems to be effective as an antidepressant, however, some confusion remains about the best parameters to apply and the efficacy of its association with pharmacological antidepressant treatments. METHOD:In a single blind randomized study 14 patients with unipolar resistant depression to one antidepressant treatment were enrolled to receive, in combination with venlafaxine (150?mg), either 20 sessions of 10?Hz rTMS (2000 pulses per session) applied over the left dorsolateral prefrontal cortex (DLPFC) or 20 sessions of 1?Hz rTMS (120 stimulations per sessions) applied over the right DLPFC. RESULTS:A similar antidepressant effect was observed in both groups with a comparable antidepressant delay of action (2?weeks) and a comparable number of responders (MADRS?<?15) after 4?weeks of daily rTMS sessions (66 vs 50%). CONCLUSION:Low- and high- frequency rTMS seems to be effective as an add-on treatment to venlafaxine as monotherapy in pharmacological refractory major depression (stage 1). Due to its short duration (one session of 1?Hz rTMS lasts 4?min vs 16 for 10?Hz rTMS) and its safety, low frequency rTMS may be a useful alternative treatment for patients with refractory depression.

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Project description:BackgroundRepetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment for depression that is increasingly implemented in healthcare systems across the world. A new form of rTMS called intermittent theta burst stimulation (iTBS) can be delivered in 3 min and has demonstrated comparable effectiveness to the conventional 37.5 min 10Hz rTMS protocol in patients with depression.ObjectivesTo compare the direct treatment costs per course and per remission for iTBS compared to 10Hz rTMS treatment in depression.MethodsWe conducted a cost analysis from a healthcare system perspective using patient-level data from a large randomized non-inferiority trial (THREE-D). Depressed adults 18 to 65 received either 10Hz rTMS or iTBS treatment. Treatment costs were calculated using direct healthcare costs associated with equipment, coils, physician assessments and technician time over the course of treatment. Cost per remission was estimated using the proportion of patients achieving remission following treatment. Deterministic sensitivity analyses and non-parametric bootstrapping was used to estimate uncertainty.ResultsFrom a healthcare system perspective, the average cost per patient was USD$1,108 (SD 166) for a course of iTBS and $1,844 (SD 304) for 10Hz rTMS, with an incremental net savings of $735 (95% CI 688 to 783). The average cost per remission was $3,695 (SD 552) for iTBS and $6,146 (SD 1,015) for 10Hz rTMS, with an average incremental net savings of $2,451 (95% CI 2,293 to 2,610).ConclusionsThe shorter session durations and treatment capacity increase associated with 3 min iTBS translate into significant cost-savings per patient and per remission when compared to 10Hz rTMS.

| S-EPMC6742475 | biostudies-literature

Citalopram for continuation therapy after repetitive transcranial magnetic stimulation in vascular depression.

Project description:The authors previously reported that repetitive transcranial magnetic stimulation (rTMS) produced a response rate of 39.4% among 62 patients with treatment resistant vascular depression. This study was undertaken to assess the outcome of continuation therapy to prevent relapse among these patients during 9 weeks after completion of rTMS.Patients were randomly assigned to 18,000 pulses of rTMS given over 3 weeks or sham treatment using double blind methods. After rTMS, all patients were given 20 mg/day of citalopram for 9 weeks and reevaluated at 3, 6, and 9 weeks.Outpatient continuation treatment trial.Patients with vascular depression (N = 62), as determined by magnetic resonance imaging hyperintensities and three or more clinical risk factors for vascular disease without other major medical illness, were recruited. They had onset of major depression after age 50 and failed at least one trial of antidepressants.After rTMS or sham treatment, all treatment responders were given citalopram for 9 weeks.Among the 33 patients who were given rTMS, 13 responded (i.e., >50% decline in Hamilton Depression Scale score). Of these 13, all completed the 9 weeks of continuation treatment. There were nine patients who continued to be responders and four who had a relapse of depression.More effective methods are needed to treat elderly patients with treatment resistant vascular depression and to prevent relapse among treatment responders.

| S-EPMC2758492 | biostudies-literature

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