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TMS for Resistant Depression: Long-Term Results Are In

Caroline Cassels | Mar 24, 2013
Medscape Medical News © 2013 WebMD, LLC
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SAN FRANCISCO — Transcranial magnetic stimulation (TMS) appears to offer long-term efficacy in patients with treatment-resistant major depressive disorder (TR-MDD), new research shows.

Presented here at the American Psychiatric Association’s 2013 Annual Meeting, the multicenter, longitudinal, naturalistic, observational study showed that acute TMS induced “statistically and clinically meaningful response and remission” in patients with TR-MDD during the acute phase, and that the results were maintained at 52 weeks.

“This is the first study to examine 12-month outcomes of TMS in a large dataset in a real-life setting. We have data on 257 patients that got all the way through the long-term follow-up, and we found that 68% improved and 45% had complete remission at 1 year follow-up,” study investigator Linda L. Carpenter, MD, professor, Department of Psychiatry and Human Behavior, Brown University School of Medicine, and chief, Mood Disorders Program, Butler Hospital, in Providence, Rhode Island, told Medscape Medical News.

I think this will really be impressive for confirming the long-term durability of this effect to potential payers. This is exciting times for psychiatrists and patients, who have a new treatment option to pursue,” […]

-Linda L. Carpenter, MD

Previous research has shown that TMS is a safe and effective acute treatment option for patients with TR-MDD. However, the long-term efficacy and durability of the treatment in this patient population were unclear.

To assess the changes in depressive symptoms and functional capacity across the duration of acute and long-term follow-up of TMS treatment, the investigators studied 307 depressed patients who were part of a prospective multicenter observational clinical trial examining the utilization and outcomes of the NeuroStar TMS Therapy System (Neuronetics Inc, Malvern, Pennsylvania).

Study participants had a primary diagnosis of unipolar, nonpsychotic major depressive disorder and had failed to receive benefit from prior antidepressant treatment. The mean age of the participants was 48.6 ± 14.2 years, and 66.8% were women.

The study’s primary outcomes included Clinical Global Impressions–Severity of Illness Scale (CGI-S), Patient Health Questionnaire (PHQ-9), and the Self-Rated Inventory for Depression Symptomatology (IDS-SR).

All patients initially received the standard simulation protocol (120% of motor threshold, 10-Hz cycles of 4 seconds of active stimulation followed by 26 seconds of no stimulation for a total of 3000 pulses per treatment session), but this could change to meet patient needs. Treatment was received daily for a period of 4 to 6 weeks.

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Dr. Janicak reports that he has received grant/research support from Janssen-Ortho Pharmaceutica Inc, Neuronectics Inc, Otsuka Pharmaceuticals, and Sunovion Pharmaceutical Inc. Dr. Carpenter reports that she is a consultant for Abbott Laboratories, Johnson & Johnson, and Lundbeck and that she has received grant/research support from NeoSync, Medtronic Inc, Neuronetics, and the National Institute of Mental Health. Dr. Dunner has disclosed no relevant financial relationships. The remaining authors are employees of Neuronetics Inc. Dr. George reports no relevant financial relationships, he reports that he does not take money from TMS manufacturers for speaking or consulting, and he reports that he does not own equity in any device or drug company.

The American Psychiatric Association’s 2013 Annual Meeting. Abstract NR12-5. Presented May 21, 2013.