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Augmentative Repetitive Transcranial Magnetic Stimulation (rTMS) in the Acute Treatment of Poor Responder Depressed Patients: A Comparison Study Between High and Low Frequency Stimulation

Published online by Cambridge University Press:  15 April 2020

B. Dell’Osso ,
L. Oldani ,
G. Camuri ,
C. Dobrea ,
L. Cremaschi ,
B. Benatti ,
C. Arici ,
B. Grancini  and
A. Carlo Altamura
B. Dell’Osso*
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy Bipolar Disorders Clinic, Stanford Medical School, Stanford University, CA, USA
L. Oldani
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
G. Camuri
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
C. Dobrea
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
L. Cremaschi
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
B. Benatti
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
C. Arici
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
B. Grancini
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
A. Carlo Altamura
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122Milano, Italy
*
⁎Corresponding author. Tel.: +02 55 03 5994; Fax: +02 50 32 0310. E-mail address:[email protected] (B. Dell'Osso).
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Abstract

Background:

While the efficacy of repetitive transcranial magnetic stimulation (rTMS) in Major Depressive Disorder (MDD) is well established, the debate is still open in relation to bipolar depression and to a possible different effectiveness of high vs. low stimulation. The present study was aimed to assess and compare the efficacy and tolerability of different protocols of augmentative rTMS in a sample of patients with current Major Depressive Episode (MDE), poor drug response/treatment resistance and a diagnosis of MDD or bipolar disorder.

Methods:

Thirty-three patients were recruited in a 4-week, blind-rater, rTMS trial and randomised to the following three groups of stimulation: (1) (n = 10) right dorsolateral prefrontal cortex (DLPFC) 1 HZ, 110% of the motor threshold (MT), 420 stimuli/day; (2) (n = 10) right DLPFC, 1 Hz, 110% MT, 900 stimuli/day; (3) (n = 13) left DLPFC, 10 Hz, 80% MT, 750 stimuli/day.

Results:

Twenty-nine patients completed the treatment, showing a significant reduction of primary outcome measures (HAM-D, MADRS and CGI-S total scores: t = 8.1, P < 0.001; t = 8.6, P < 0.001; t = 4.6, P < 0.001 respectively). No significant differences in terms of efficacy and tolerability were found between high vs. low frequency and between unipolar and bipolar patients. Side effects were reported by 21% of the sample. One of the 4 dropouts was caused by a hypomanic switch.

Conclusions:

Augmentative rTMS appeared to be effective and well tolerated for the acute treatment of unipolar and bipolar depression with features of poor drug response/treatment resistance, showing a comparable effectiveness profile between protocols of high and low frequency stimulation.

Keywords

Repetitive transcranial magnetic stimulation (rTMS)AugmentationPoor drug responseTreatment resistanceMajor depressive disorderBipolar disorder
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 2 , February 2015 , pp. 271 - 276
Copyright
Copyright © Elsevier Masson SAS 2014

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