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Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study.

Publication ,  Journal Article
Donse, L; Padberg, F; Sack, AT; Rush, AJ; Arns, M
Published in: Brain Stimul
2018

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is considered an efficacious non-invasive neuromodulation treatment for major depressive disorder (MDD). However, little is known about the clinical outcome of combined rTMS and psychotherapy (rTMS + PT). Through common neurobiological brain mechanisms, rTMS + PT may exert enhanced antidepressant effects compared to the respective monotherapies. OBJECTIVE: The current naturalistic study aimed to evaluate feasibility and clinical outcome of rTMS + PT in a large group of MDD patients. The second aim was to identify clinical predictors of response and remission. METHODS: A total of 196 patients with MDD were treated with at least 10 sessions of simultaneous rTMS and PT. rTMS was applied over the DLPFC, either 10 Hz left or 1 Hz right. Psychotherapy was based on principles of cognitive behavioral therapy (CBT). Symptoms were measured using the BDI each fifth session until end of treatment and at 6-month follow-up. Comparisons were made between responders and non-responders, as well as between the 10 Hz and 1 Hz protocol. Additionally, baseline variables and early BDI change were evaluated as predictors of response/remission. MAJOR FINDINGS AND CONCLUSIONS: 1) Combining rTMS and PT resulted in a 66% response and a 56% remission rate at the end of treatment with 60% sustained remission at follow-up. Compared to previous findings in RCTs, these rates are relatively high; 2) No differences were found between the 10 Hz and 1 Hz TMS regarding clinical outcome; 3) Clinical baseline variables were not predictive of treatment outcomes; 4) Early symptom improvement (at session 10) was highly predictive of response, and may therefore be used to guide rTMS + PT continuation; 5) Based on the current findings in a large naturalistic study, future studies employing a more standardized method are warranted to draw solid conclusions on the unique effect of rTMS + PT.

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Published In

Brain Stimul

DOI

EISSN

1876-4754

Publication Date

2018

Volume

11

Issue

2

Start / End Page

337 / 345

Location

United States

Related Subject Headings

  • Transcranial Magnetic Stimulation
  • Psychotherapy
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Female
  • Depressive Disorder, Major
  • Adult
  • 42 Health sciences
 

Citation

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ICMJE
MLA
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Donse, L., Padberg, F., Sack, A. T., Rush, A. J., & Arns, M. (2018). Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study. Brain Stimul, 11(2), 337–345. https://doi.org/10.1016/j.brs.2017.11.004
Donse, Lana, Frank Padberg, Alexander T. Sack, A John Rush, and Martijn Arns. “Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study.Brain Stimul 11, no. 2 (2018): 337–45. https://doi.org/10.1016/j.brs.2017.11.004.
Donse, Lana, et al. “Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study.Brain Stimul, vol. 11, no. 2, 2018, pp. 337–45. Pubmed, doi:10.1016/j.brs.2017.11.004.
Journal cover image

Published In

Brain Stimul

DOI

EISSN

1876-4754

Publication Date

2018

Volume

11

Issue

2

Start / End Page

337 / 345

Location

United States

Related Subject Headings

  • Transcranial Magnetic Stimulation
  • Psychotherapy
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Female
  • Depressive Disorder, Major
  • Adult
  • 42 Health sciences