Predictors of response to synchronized transcranial magnetic stimulation for major depressive disorder. Issue 3 (27th November 2018)

• Record Type: Journal Article
• Authors: Philip, Noah S.; Leuchter, Andrew F.; Cook, Ian A.; Massaro, Joe; Goethe, John W.; Carpenter, Linda L.
• Is Part Of: Depression and anxiety. Volume 36:Issue 3(2019)
• Page Start: 278
• Page End: 285
• Publication Date: 2018-11-27
• Subjects: anxiety -- brain stimulation -- individualized alpha frequency -- major depressive disorder -- predictors of response -- synchronized transcranial magnetic stimulation; Anxiety -- Periodicals; Depression, Mental -- Periodicals; Depression -- Periodicals; Anxiety -- Periodicals; Anxiety Disorders -- Periodicals; 616.8527005
• DOI: 10.1002/da.22862
• Languages: English
• ISSNs: 1091-4269

Abstract

Abstract : Background: Synchronized transcranial magnetic stimulation (sTMS) is a new modality to reduce symptoms of major depressive disorder (MDD). sTMS uses rotating neodymium magnets to deliver low‐field stimulation matched to the individual alpha frequency (IAF). A previous multisite study showed that sTMS significantly reduced MDD symptoms in the per‐protocol sample. To this end, we evaluated clinical features associated with optimal sTMS outcomes. Methods: Using the per‐protocol sample ( n = 120) from the parent sham‐controlled trial, we performed univariate and stepwise linear regression to identify predictors of response after 6 weeks of sTMS. A subsample ( n = 83) that entered a 4‐week open/active continuation phase also was examined. Candidate variables included age, sex, comorbid anxiety, number of failed antidepressants in the current depressive episode, MDD severity (17‐item Hamilton Depression Rating Scale; HAMD17), anxiety symptom severity (HAMD17 anxiety/somatization factor), and IAF. Results: We found that greater baseline depressive ( p < 0.001) and anxiety ( p < 0.001) symptom severity were associated with better response to active sTMS, whereas fewer failed antidepressant trials predicted superior response to sham ( p < 0.001). MDD severity and antidepressant resistance predicted outcomes in open/active phase sTMS; lower IAF predicted poorer response in participants who received 10 weeks of active sTMS ( p = 0.001). Conclusions: Participants with greater severity of depression and higher anxiety had superior responses to active sTMS, whereas treatment naïve individuals exhibited a greater response to sham. These results lend support to the primary efficacy findings, and support further investigation of sTMS as a therapeutic noninvasive brain stimulation modality.