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Transcranial Magnetic Stimulation More Effective for Depression in Those with Less Medication Resistance

In a study of Transcranial Magnetic Stimulation (TMS) for depression published online this week in the journal Neuropsychopharmacology, researchers reported that patients suffering from major depression were more likely to benefit from TMS if they had failed to respond to one antidepressant medication in their current episode. This pivotal study, noted the paper’s authors, provides critical information regarding the patient population for whom TMS is likely to be most effective.

Lead author on this report, Dr. Sarah Lisanby, Director of the Division of Brain Stimulation and Therapeutic Modulation in the Department of Psychiatry at Columbia University and New York State Psychiatric Institute (NYPSI), was the principal investigator of the NYSPI site, one of 23 international centers involved in the study. A total of 301 patients were randomized to real TMS or sham in the first phase of the study. The second phase, an extension of the first that lasted six weeks, provided real TMS to patients who had participated in the first phase for at least four weeks and had not improved significantly.

“A total of 164 patients had received one antidepressant treatment trial of adequate dose and duration in the current episode, with the remainder of the patients receiving from two to four adequate treatment trials,” the authors wrote. Results showed that a lower degree of medication resistance predicted better antidepressant response to TMS, a finding that is consistent with earlier reports that medication resistance was a predictor of response to medications.

Prior studies had identified a number of factors that predicted response to TMS, including duration of current episode of depression and severity of illness at baseline. The current multi-site study found that improved response was associated with shorter illness duration as well as greater severity of depression at baseline.

Treatment parameters in this study established a repetition rate of 10 pulses per second (10 Hz) for a total of 3000 pulses in each treatment session to the left dorsolateral prefrontal cortex.

“These results may be useful in guiding patient selection, for the design of future studies on the clinical efficacy of TMS, and also in defining the appropriate phase of illness for which TMS would be most effective,” the authors concluded.

TMS is an investigative device that holds promise for the treatment of psychiatric disorders including depression. The ability of TMS to non-invasively stimulate specific brain regions without the need for anesthesia would make it an attractive alternative when medications fail, should the device become available for the treatment of depression.

Dr. Lisanby is Chief of the Columbia Brain Stimulation and Neuromodulation Division and Professor of Clinical Psychiatry. This Division focuses on the use of emerging electromagnetic means of modulating brain function to study and treat psychiatric disorders. These techniques include transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), magnetic seizure therapy (MST), deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and electroconvulsive therapy (ECT).

Dr. Lisanby became internationally recognized as a leader in the field of TMS when her research team innovated the use of TMS to perform a safer version of convulsive therapy—a procedure termed Magnetic Seizure Therapy (MST). She is the Chairperson of the American Psychiatric Association Task Force on ECT, the President of the International Society for Transcranial Stimulation, immediate past President and Fellow of the Association for Convulsive Therapy, and a Member of the American College of Neuropsychopharmacology, among others. Dr. Lisanby is the recipient of over 35 honors and awards, including the Gerald L. Klerman Award presented by the National Alliance for Research in Schizophrenia and Depression, and the 2004 Max Hamilton Memorial Prize of the Collegium Internationale Neuro-Psychopharmacologicum (CINP).

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