Concomitant medication use and clinical outcome of repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder. Issue 5 (2nd April 2019)

• Record Type: Journal Article
• Authors: Hunter, Aimee M.; Minzenberg, Michael J.; Cook, Ian A.; Krantz, David E.; Levitt, Jennifer G.; Rotstein, Natalie M.; Chawla, Shweta A.; Leuchter, Andrew F.
• Is Part Of: Brain and behavior. Volume 9:Issue 5(2019)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2019-04-02
• Subjects: adrenergic -- benzodiazepines -- gamma‐aminobutyric acid (GABA) -- Major Depressive Disorder -- psychostimulants -- repetitive transcranial magnetic stimulation (rTMS) -- treatment outcome; Neurology -- Periodicals; Neurosciences -- Periodicals; Psychology -- Periodicals; Psychiatry -- Periodicals; 616.8005
• DOI: 10.1002/brb3.1275
• Languages: English
• ISSNs: 2162-3279

Abstract

Abstract: Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is commonly administered to Major Depressive Disorder (MDD) patients taking psychotropic medications, yet the effects on treatment outcomes remain unknown. We explored how concomitant medication use relates to clinical response to a standard course of rTMS. Methods: Medications were tabulated for 181 MDD patients who underwent a six‐week rTMS treatment course. All patients received 10 Hz rTMS administered to left dorsolateral prefrontal cortex (DLPFC), with 1 Hz administered to right DLPFC in patients with inadequate response to and/or intolerance of left‐sided stimulation. Primary outcomes were change in Inventory of Depressive Symptomatology Self Report (IDS‐SR30) total score after 2, 4, and 6 weeks. Results: Use of benzodiazepines was associated with less improvement at week 2, whereas use of psychostimulants was associated with greater improvement at week 2 and across 6 weeks. These effects were significant controlling for baseline variables including age, overall symptom severity, and severity of anxiety symptoms. Response rates at week 6 were lower in benzodiazepine users versus non‐users (16.4% vs. 35.5%, p = 0.008), and higher in psychostimulant users versus non‐users (39.2% vs. 22.0%, p = 0.02). Conclusions: Concomitant medication use may impact rTMS treatment outcome. While the differences reported here could be considered clinically significant, results were not corrected for multiple comparisons and findings should be replicated before clinicians incorporate the evidence into clinical practice. Prospective, hypothesis‐based treatment studies will aid in determining causal relationships between medication treatments and outcome. Abstract : Repetitive Transcranial Magnetic Stimulation (rTMS) is commonly used to treat Major Depressive Disorder (MDD) patients who are taking psychotropic medications, yet the effects on treatment outcome remains unknown. Exploratory hypothesis‐generating analyses of concomitant medication use in a clinical sample ( n = 181) suggested that specific categories of medication use (psychostimulants and benzodiazepines, respectively) may be associated with better or worse outcome to an acute course of rTMS. Prospective, hypothesis‐based treatment studies are needed to determine potential causal relationships between medication treatments and outcome.