Clinical Predictors of Response to rTMS in Patients with Depressive Disorder

Document Type : Research Paper

Author

Department of Health Psychology, faculty of psychology and Educational Science, University of Tehran

Abstract

 
Repetitive Transcranial Magnetic Stimulation (rTMS) on prefrontal cortex is a new approach in patients diagnosed with depression. rTMS treatment response is different on different patients. Identifying response predictors plays a key role in treating patients with depression using rTMS. This research has aimed to study the demographic and clinical predictors of response to rTMS in patients with depression. This is a natural retrospective study on 248 patients with depression. The patients underwent rTMS treatment in Atieh Clinical Neurosciences Center, Tehran, Iran from May 2012 to December 2014 in order to treat their depression. Three common rTMS protocols were employed for the treatment: High-Frequency Stimulation, Low-Frequency Stimulation, and Bilateral Stimulation of the dorsolateral prefrontal cortex. All patients received rTMS three days a week for one month. Response to treatment was defined by the Beck Depression Inventory (BDI-II) and 50% reduction of scores compared to the baseline. Data were analyzed using logistic regression. Out of 248 patients, 110 (44%) responded to rTMS. Out of 98 patients with unipolar depression, 50 (51%) responded to rTMS. Similarly, out of 142 patients with bipolar depression, 60 (42%) responded to the treatment. Age, pessimism, sense of failure, agitation, loss of interest, indecisiveness, irritability, and somatic preoccupation were predictor variables of response to treatment in all patients. Among unipolar depressive patients, loss of interest, and somatic preoccupation, loss of energy and worthlessness were found to be the predictor variables, while sadness, feelings of failure, self-criticalness, irritability, loss of interest, change in sleep patterns, and somatic preoccupation were found to be the predictor variables of response to treatment in bipolar depressive patients. Age and clinical predictor variables can be used to predict the response to rTMS treatment.

Keywords


دابسون استفان، محمدخانی پروانه (1386).  مختصات روانسنجی پرسشنامه ی افسردگی - 2 در مبتلایان به افسردگی اساسی در دوره ی بهبودی نسبی. توانبخشی(8)8-80 .
رجبی، غلامرضا؛ عطاری، یوسف علی؛ حقیقی، جمال (1380) .  تحلیل عاملی سؤالهای پرسشنامه بک بر روی دانشجویان پسر دانشگاه شهید چمران اهواز. مجله علوم تربیتی و روانشناسی دانشگاه شهید چمران اهواز. 3 (8) .66-49
Avery, D., & Silverman, J. (1984). Psychomotor retardation and agitation in depression: relationship to age, sex, and response to treatment. Journal of affective disorders, 7(1), 67-76.
Barber, J. P., & Muenz, L. R. (1996). The role of avoidance and obsessiveness in matching patients to cognitive and interpersonal psychotherapy: empirical findings from the treatment for depression collaborative research program. Journal of consulting and clinical psychology, 64(5), 951.
Berlim, M. T., Van den Eynde, F., & Daskalakis, Z. J. (2013). Clinically meaningful efficacy and acceptability of low-frequency repetitive transcranial magnetic stimulation (rTMS) for treating primary major depression: a meta-analysis of randomized, double-blind and sham-controlled trials. Neuropsychopharmacology, 38(4), 543-551.
Bosch, N. M., Riese, H., Dietrich, A., Ormel, J., Verhulst, F. C., & Oldehinkel, A. J. (2009). Preadolescents' somatic and cognitive-affective depressive symptoms are differentially related to cardiac autonomic function and cortisol: the TRAILS study. Psychosomatic Medicine, 71(9), 944-950.
Brakemeier, E. L., Luborzewski, A., Danker-Hopfe, H., Kathmann, N., & Bajbouj, M. (2007). Positive predictors for antidepressive response to prefrontal repetitive transcranial magnetic stimulation (rTMS). Journal of psychiatric research, 41(5), 395-403.
Brandon, S., Cowley, P., McDonald, C., Neville, P., Palmer, R., & Wellstood-Eason, S. (1984). Electroconvulsive therapy: results in depressive illness from the Leicestershire trial. Br Med J (Clin Res Ed), 288(6410), 22-25.
Carpenter, L. L., Janicak, P. G., Aaronson, S. T., Boyadjis, T., Brock, D. G., Cook, I. A.,...& Demitrack, M. A. (2012). Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depression and anxiety, 29(7), 587-596.
Cipriani, A., Furukawa, T. A., Salanti, G., Geddes, J. R., Higgins, J. P., Churchill, R.,...& Tansella, M. (2009). Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. The Lancet, 373(9665), 746-758.
Cohen, R. B., Brunoni, A. R., Boggio, P. S., & Fregni, F. (2010). Clinical predictors associated with duration of repetitive transcranial magnetic stimulation treatment for remission in bipolar depression: a naturalistic study. The Journal of nervous and mental disease, 198(9), 679-681.
Dawson, G., Klinger, L. G., Panagiotides, H., Hill, D., & Spieker, S. (1992). Frontal lobe activity and affective behavior of infants of mothers with depressive symptoms. Child Development, 63(3), 725-737.
de Jonge, P., Mangano, D., & Whooley, M. A. (2007). Differential association of cognitive and somatic depressive symptoms with heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. Psychosomatic medicine, 69(8), 735. de Jonge, P., Ormel, J., van den Brink, R. H., van Melle, J. P., Spijkerman, T. A., Kuijper, A.,... & Schene, A. H. (2006). Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. American Journal of Psychiatry, 163(1), 138-144.
de Miranda Azevedo, R., Roest, A. M., Hoen, P. W., & de Jonge, P. (2014). Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: a meta-analysis. Psychological medicine, 44(13), 2689-2703.
Dimidjian , S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E.,... & Atkins, D. C. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of consulting and clinical psychology, 74(4), 658.
Downar, J., & Daskalakis, Z. J. (2013). New targets for rTMS in depression: a review of convergent evidence. Brain stimulation, 6(3), 231-240. Downing, R. W., & Rickels, K. (1972). Predictors of amitriptyline response in outpatient depressives. The Journal of nervous and mental disease, 154(4), 248-263.
Dunner, D. L., Aaronson, S. T., Sackeim, H. A., Janicak, P. G., Carpenter, L. L., Boyadjis, T.,... & Lanocha, K. (2014). A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period. The Journal of clinical psychiatry, 75(12), 1394-1401.
 Epstein, C. M., Figiel, G. S., McDonald, W. M., Amazon-Leece, J., & Figiel, L. (1998). Rapid rate transcranial magnetic stimulation in young and middle-aged refractory depressed patients. Psychiatric Annals, 28(1), 36-39.
Erzegovesi, S., Cavallini, M. C., Cavedini, P., Diaferia, G., Locatelli, M., & Bellodi, L. (2001). Clinical predictors of drug response in obsessive-compulsive disorder. Journal of clinical psychopharmacology, 21(5), 488-492.
Figiel, G. S., Epstein, C., McDonald, W. M., Amazon-Leece, J., Figiel, L., Saldivia, A., & Glover, S. (1998). The use of rapid-rate transcranial magnetic stimulation (rTMS) in refractory depressed patients. The Journal of neuropsychiatry and clinical neurosciences, 10(1), 20-25.
Fitzgerald, P. B., Brown, T. L., Marston, N. A., Daskalakis, Z. J., de Castella, A., & Kulkarni, J. (2003). Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Archives of General Psychiatry, 60(10), 1002-1008.
Fregni, F., Marcolin, M. A., Myczkowski, M., Amiaz, R., Hasey, G., Rumi, D. O.,...& Heaslip, J. (2006). Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation. The International Journal of Neuropsychopharmacology, 9(06), 641-654.
Gartlehner, G., Hansen, R. A., Morgan, L. C., Thaler, K., Lux, L., Van Noord, M.,... & Strobelberger, M. (2011). Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis. Annals of internal medicine, 155(11), 772-785.
Gross, M., Nakamura, L., Pascual‐Leone, A., & Fregni, F. (2007). Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression improved? A systematic review and meta‐analysis comparing the recent vs. the earlier rTMS studies. Acta Psychiatrica Scandinavica, 116(3), 165-173.
Hama, S., Yamashita, H., Shigenobu, M., Watanabe, A., Kurisu, K., Yamawaki, S., & Kitaoka, T. (2007). Post-stroke affective or apathetic depression and lesion location: left frontal lobe and bilateral basal ganglia. European archives of psychiatry and clinical neuroscience, 257(3), 149-152.
Jhanwar, V. G., Bishnoi, R. J., & Jhanwar, M. R. (2011). Utility of repetitive transcranial stimulation as an augmenting treatment method in treatment-resistant depression. Indian journal of psychological medicine, 33(1), 92.
 John Rush, A., Carmody, T. J., Haight, B. R., Rockett, C. B., & Zisook, S. (2005). Does pretreatment insomnia or anxiety predict acute response to bupropion SR?. Annals of Clinical Psychiatry, 17(1), 1-9.
Johnstone, E., Lawler, P., Stevens, M., Deakin, J. F. W., Frith, C. D., McPherson, K., & Crow, T. J. (1980). The Northwick Park electroconvulsive therapy trial. The Lancet, 316(8208), 1317-1320.
Joyce, P. R., McKENZIE, J. M., Carter, J. D., Rae, A. M., Luty, S. E., Frampton, C. M., & Mulder, R. T. (2007). Temperament, character and personality disorders as predictors of response to interpersonal psychotherapy and cognitive–behavioural therapy for depression. The British Journal of Psychiatry, 190(6), 503-508.Joyce, P. R., & Paykel, E. S. (1989). Predictors of drug response in depression. Archives of General Psychiatry, 46(1), 89-99.
Kelly, M. S., Oliveira-Maia, A. J., Bernstein, M., Stern, A. P., Press, D. Z., Pascual-Leone, A., & Boes, A. D. (2016). Initial Response to Transcranial Magnetic Stimulation Treatment for Depression Predicts Subsequent Response. The Journal of Neuropsychiatry and Clinical Neurosciences, appi-neuropsych.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593-602.
Kozel, F. A., George, M. S., & Simpson, K. N. (2004). Decision analysis of the cost-effectiveness of repetitive transcranial magnetic stimulation versus electroconvulsivetherapy for treatment of nonpsychotic severe depression. CNS spectrums, 9(06), 476-482.
Kozel, F. A., Nahas, Z., Debrux, C., Molloy, M., Lorberbaum, J. P., Bohning, D.,...& George, M. S. (2000). How coil-cortex distance relates to age, motor threshold, and antidepressant response to repetitive transcranial magnetic stimulation. The Journal of neuropsychiatry and clinical neurosciences, 12(3), 376-384.
Labermaier, C., Masana, M., & Müller, M. B. (2013). Biomarkers predicting antidepressant treatment response: how can we advance the field?. Disease markers, 35(1), 23-31.
Lam, R. W., Milev, R., Rotzinger, S., Andreazza, A. C., Blier, P., Brenner, C.,...& Farzan, F. (2016). Discovering biomarkers for antidepressant response: protocol from the Canadian biomarker integration network in depression (CAN-BIND) and clinical characteristics of the first patient cohort.
BMC psychiatry, 16(1), 1. Liu, B., Zhang, Y., Zhang, L., & Li, L. (2014). Repetitive transcranial magnetic stimulation as an augmentative strategy for treatment-resistant depression, a meta-analysis of randomized, double-blind and sham-controlled study. BMC psychiatry, 14(1), 1.
 Manes, F., Jorge, R., Morcuende, M., Yamada, T., Paradiso, S., & Robinson, R. G. (2001). A controlled study of repetitive transcranial magnetic stimulation as a treatment of depression in the elderly. International Psychogeriatrics, 13(02), 225-231.
McBride, C., Atkinson, L., Quilty, L. C., & Bagby, R. M. (2006). Attachment as moderator of treatment outcome in major depression: a randomized control trial of interpersonal psychotherapy versus cognitive behavior therapy. Journal of consulting and clinical psychology, 74(6), 1041.
McLoughlin, D. M., Mogg, A., Eranti, S., Pluck, G., Purvis, R., Edwards, D...& Philpot, M. (2007). The clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus electroconvulsive therapy in severe depression: a multicentre pragmatic randomised controlled trial and economic analysis. Health technology assessment (Winchester, England), 11(24), 1-54.
McNamara, B., Ray, J. L., Arthurs, O. J., & Boniface, S. (2001). Transcranial magnetic stimulation for depression and other psychiatric disorders. Psychological medicine, 31(07), 1141-1146.
Mehta, R., Jain, R. K., & Badve, S. (2011). Personalized medicine: the road ahead. Clinical breast cancer, 11(1), 20-26.
Mishra, B. R., Sarkar, S., Praharaj, S. K., Mehta, V. S., Diwedi, S., & Nizamie, S. H. (2011). Repetitive transcranial magnetic stimulation in psychiatry. Annals of Indian Academy of Neurology, 14(4), 245.
Mosimann, U. P., Schmitt, W., Greenberg, B. D., Kosel, M., Müri, R. M., Berkhoff, M.,...& Schlaepfer, T. E. (2004). Repetitive transcranial magnetic stimulation: a putative add-on treatment for major depression in elderly patients. Psychiatry research, 126(2), 123-133.
Mulder, R. T. (2002). Personality pathology and treatment outcome in major depression: a review. American Journal of Psychiatry, 159(3), 359-371.
Myers, A. J., & Nemeroff, C. B. (2010). New vistas in the management of treatment-refractory psychiatric disorders: Genomics and personalized medicine. Focus, 8(4), 525-535.
Nahas, Z., Li, X., Kozel, F. A., Mirzki, D., Memon, M., Miller, K.,...& Mintzer, J.(2004). Safety and benefits of distance‐adjusted prefrontal transcranial magnetic stimulation in depressed patients 55–75 years of age: A pilot study. Depression and anxiety, 19(4), 249-256.
Newton-Howes, G., Tyrer, P., & Johnson, T. (2006). Personality disorder and the outcome of depression: meta-analysis of published studies. The British Journal of Psychiatry, 188(1), 13-20.
Overall, J. E., Hollister, L. E., Johnson, M., & Pennington, V. (1966). Nosology of depression and differential response to drugs. JAMA, 195(11), 946-948.
Ozomaro, U., Wahlestedt, C., & Nemeroff, C. B. (2013). Personalized medicine in psychiatry: problems and promises. BMC medicine, 11(1), 1.
Pallanti, S., Cantisani, A., Grassi, G., Antonini, S., Cecchelli, C., Burian, J.,...& Quercioli, L. (2012). rTMS age-dependent response in treatment-resistant depressed subjects: a mini-review. CNS spectrums, 17(01), 24-30.
Pochon, J. B., Levy, R., Poline, J. B., Crozier, S., Lehéricy, S., Pillon, B.,...& Dubois, B. (2001). The role of dorsolateral prefrontal cortex in the preparation of forthcoming actions: an fMRI study. Cerebral Cortex, 11(3), 260-266.
Parikh, S. V., & Lam, R. W. (2001). Clinical guidelines for the treatment of depressive disorders, I. Definitions, prevalence, and health burden. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 46, 13S-20S.
Riedel, M., Möller, H. J., Obermeier, M., Schennach-Wolff, R., Bauer, M., Adli, M.,...& Bender, W. (2010). Response and remission criteria in major depression–a validation of current practice. Journal of psychiatric research, 44(15), 1063-1068.
Robinson, D. G., Woerner, M. G., Alvir, J. M. J., Geisler, S., Koreen, A., Sheitman, B.,...& Lieberman, J. A. (1999). Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. American Journal of Psychiatry.
Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Stewart, J. W., Nierenberg, A. A., Thase, M. E.,... & Shores-Wilson, K. (2006). Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. New England Journal of Medicine, 354(12), 1231-1242.
Schüle, C., Zwanzger, P., Baghai, T., Mikhaiel, P., Thoma, H., Möller, H. J.,...& Padberg, F. (2003). Effects of antidepressant pharmacotherapy after repetitive transcranial magnetic stimulation in major depression: an open follow-up study. Journal of psychiatric research, 37(2), 145-153.
Simon, G. E., & Perlis, R. H. (2010). Personalized medicine for depression: can we match patients with treatments?.American Journal of Psychiatry, 167(12), 1445-1455.
Simon, G. E., Von Korff, M., Rutter, C. M., & Peterson, D. A. (2001). Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Archives of General Psychiatry, 58(4), 395-401.
Sotsky, S. M., Glass, D. R., Shea, M. T., Pilkonis, P. A., Collins, J. F., Elkin, I.,...& Oliveri, M. E. (1991). Patient predictors of response to psychotherapy and pharmacotherapy: findings in the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry, 148(8), 997-1008.
Strian, F., Albert, W., & Klicpera, C. (1979). Course of depressive mood and psychomotor activation in endogenous depression. Archiv für Psychiatrie und Nervenkrankheiten, 227(3), 193-206.
Tarhan, N., Sayar, F. G. H., Tan, O., & Kağan, G. (2012). Efficacy of high-frequency repetitive transcranial magnetic stimulation in treatment-resistant depression. Clinical EEG and neuroscience, 43(4), 279-284.
Thase, M. E., Friedman, E. S., Biggs, M. M., Wisniewski, S. R., Trivedi, M. H., Luther, J. F.,... &Niederehe, G. (2007). Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR* D report. American Journal of Psychiatry.
Trivedi, M. H., Fava, M., Wisniewski, S. R., Thase, M. E., Quitkin, F., Warden, D.,...& Luther, J. F. (2006). Medication augmentation after the failure of SSRIs for depression. New England Journal of Medicine, 354(12), 1243-1252. T
rivedi, M. H., Rush, A. J., Wisniewski, S. R., Nierenberg, A. A., Warden, D., Ritz, L.,... & Shores-Wilson, K. (2006). Evaluation of outcomes with citalopram for depression using measurement-based care in STAR* D: implications for clinical practice. American journal of Psychiatry, 163(1), 28-40.
Umbricht, D. S., Wirshing, W. C., Wirshing, D. A., McMeniman, M., Schooler, N. R., & Kane, J. M. (2002). Clinical predictors of response to clozapine treatment in ambulatory patients with schizophrenia. The Journal of clinical psychiatry, 63(5), 420-424.
Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I.,...&Duan, L. (2015). Global, regional, and national incidence, prevalence, and years livedwith disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. TheLancet, 386(9995), 743-800.
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disordersand global disease burden implications: a systematic review and meta-analysis. JAMApsychiatry, 72(4), 334-341.
World Health Organization. (1999). Figures and facts about suicide.
Zhang, Y. Q., Zhu, D., Zhou, X. Y., Liu, Y. Y., Qin, B., Ren, G. P., & Xie, P. (2015).Bilateral repetitive transcranial magnetic stimulation for treatment-resistantdepression: a systematic review and meta-analysis of randomized controlledtrials. Brazilian Journal of Medical and Biological Research, 48(3), 198-206.
Volume 8, Issue 2
August 2017
Pages 181-200
  • Receive Date: 06 November 2012
  • Revise Date: 16 September 2018
  • Accept Date: 04 August 2013
  • First Publish Date: 23 August 2017
  • Publish Date: 23 August 2017