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Non MRI Guided Accelerated Intermittent Theta Burst Stimulation is Effective in Patients with Treatment Resistant Depression and Suicidality

Published online by Cambridge University Press:  27 August 2024

A. E. Zayed ,
M. M. Bassiony ,
U. M. Youssef ,
G. M. Salah Eldeen ,
H. M. Elgohary ,
M. G. Sehlo  and
O. A. Hefny
A. E. Zayed*
Affiliation:
Psychiatry, Zagazig University, Zagazig, Egypt
M. M. Bassiony
Affiliation:
Psychiatry, Zagazig University, Zagazig, Egypt
U. M. Youssef
Affiliation:
Psychiatry, Zagazig University, Zagazig, Egypt
G. M. Salah Eldeen
Affiliation:
Psychiatry, Zagazig University, Zagazig, Egypt
H. M. Elgohary
Affiliation:
Psychiatry, Zagazig University, Zagazig, Egypt
M. G. Sehlo
Affiliation:
Psychiatry, Zagazig University, Zagazig, Egypt
O. A. Hefny
Affiliation:
Psychiatry, Zagazig University, Zagazig, Egypt
*
*Corresponding author.

Abstract

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Introduction

The U.S. Food & Drug Administration (FDA) has cleared SNT (Stanford Neuromodulation Therapy) for treatment of major depressive disorder (MDD) in adults who have failed to achieve improvement from at least two prior trials of antidepressants. SNT protocol requires both structural and functional connectivity MRIs which is limited by high cost and lack of availability, its use without neuronavigation is still considered an off label use and need more investigation.

Objectives

1-To investigate efficacy of SNT like accelerated off-label protocol without Neuronavigation in treating patients with TRD and suicidality.

2-To investigate durabiliy ( up to one month ) of SNT like accelerated off-label protocol without Neuronavigation in treating patients with TRD and suicidality

Methods

Two cases diagnosed as treatment resistant unipolar depression with suicidal ideations received accelerated intermittent theta burst stimulation (a iTBS); with figure of eight coil administered to the left dorsolateral prefrontal cortex (DL-PFC) determined using Beam method. Stimulation was at 90% MT for 1800 pulses with an intersession interval of fifty minutes. Patients received ten sessions every day for five consecutive days for a total of fifty sessions (90,000 pulses). The following scales were applied at the baseline and at the end of each day of five treatment days:The Montgomery and Asberg Depression Rating Scale (MADRS) The Beck Depression Inventory, Columbia Suicide Severity Rating Scale (C-SSRS) and Young Mania Rating Scale (YMRS).

Results

The two cases at the end of the fifth day were completely improved regarding both suicidal ideations and depression without emerging of hypomania. Follow up was done weekly for one month with durable results.

Conclusions

SNT protocol without neuronavigation needs to be well investigated in suppressing both suicidality and depression in patients with TRD.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 67 , Special Issue S1: Abstracts of the 32nd European Congress of Psychiatry , April 2024 , pp. S702
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of European Psychiatric Association
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