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Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression.

Publication ,  Journal Article
McDonald, WM; Durkalski, V; Ball, ER; Holtzheimer, PE; Pavlicova, M; Lisanby, SH; Avery, D; Anderson, BS; Nahas, Z; Zarkowski, P; Sackeim, HA ...
Published in: Depress Anxiety
November 2011

OBJECTIVE: To assess the efficacy of increasing the number of fast left repetitive transcranial magnetic stimulations (rTMS) (10 Hz @ 120% of motor threshold (MT) over the left dorsolateral prefrontal cortex (DLPFC)) needed to achieve remission in treatment-resistant depression (TRD). And, to determine if patients who do not remit to fast left will remit using slow right rTMS (1 Hz @ 120% MT over the right DLPFC). METHOD: Patients were part of a multicenter sham-controlled trial investigating the efficacy of fast left rTMS. Patients who failed to meet minimal response criteria in the sham-controlled study could enroll in this open fast left rTMS study for an additional 3-6 weeks. Patients who failed to remit to fast left could switch to slow right rTMS for up to 4 additional weeks. The final outcome measure was remission, defined as a HAM-D score of <3 or 2 consecutive HAM-D scores less than 10. RESULTS: Forty-three of 141 (30.5%) patients who enrolled in the open phase study eventually met criteria for remission. Patients who remitted during fast left treatment received a mean of 26 active treatments (90,000 pulses). Twenty-six percent of patients who failed fast left remitted during slow right treatment. CONCLUSION: The total number of rTMS stimulations needed to achieve remission in TRD may be higher than is used in most studies. TRD patients who do not respond to fast left rTMS may remit to slow right rTMS or additional rTMS stimulations.

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Published In

Depress Anxiety

DOI

EISSN

1520-6394

Publication Date

November 2011

Volume

28

Issue

11

Start / End Page

973 / 980

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Transcranial Magnetic Stimulation
  • Time Factors
  • Severity of Illness Index
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Prefrontal Cortex
  • Middle Aged
  • Male
 

Citation

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McDonald, W. M., Durkalski, V., Ball, E. R., Holtzheimer, P. E., Pavlicova, M., Lisanby, S. H., … George, M. S. (2011). Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression. Depress Anxiety, 28(11), 973–980. https://doi.org/10.1002/da.20885
McDonald, William M., Valerie Durkalski, Edward R. Ball, Paul E. Holtzheimer, Martina Pavlicova, Sarah H. Lisanby, David Avery, et al. “Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression.Depress Anxiety 28, no. 11 (November 2011): 973–80. https://doi.org/10.1002/da.20885.
McDonald WM, Durkalski V, Ball ER, Holtzheimer PE, Pavlicova M, Lisanby SH, et al. Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression. Depress Anxiety. 2011 Nov;28(11):973–80.
McDonald, William M., et al. “Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression.Depress Anxiety, vol. 28, no. 11, Nov. 2011, pp. 973–80. Pubmed, doi:10.1002/da.20885.
McDonald WM, Durkalski V, Ball ER, Holtzheimer PE, Pavlicova M, Lisanby SH, Avery D, Anderson BS, Nahas Z, Zarkowski P, Sackeim HA, George MS. Improving the antidepressant efficacy of transcranial magnetic stimulation: maximizing the number of stimulations and treatment location in treatment-resistant depression. Depress Anxiety. 2011 Nov;28(11):973–980.
Journal cover image

Published In

Depress Anxiety

DOI

EISSN

1520-6394

Publication Date

November 2011

Volume

28

Issue

11

Start / End Page

973 / 980

Location

United States

Related Subject Headings

  • Young Adult
  • Treatment Outcome
  • Transcranial Magnetic Stimulation
  • Time Factors
  • Severity of Illness Index
  • Psychiatry
  • Psychiatric Status Rating Scales
  • Prefrontal Cortex
  • Middle Aged
  • Male