An Open-Label Feasibility Study of rTMS for Treatment-Resistant Depression in the New Zealand Healthcare Context
New Zealand Medical Journal. 132(1504):46-55, 2019 10 25. AUTHORS
Godfrey KE; Muthukumaraswamy SD; Stinear CM; Hoeh NR.
Major depressive disorder (MDD) poses a significant and growing burden on the New Zealand population. It is a leading cause of disability, and resistance to currently offered treatments is common. Repetitive transcranial magnetic stimulation (rTMS) is a treatment offered internationally demonstrating good efficacy and few reports of side effects. It is an intervention that requires daily visits to a clinic over a period of at least four weeks. This study aimed to investigate the effectiveness and acceptability of offering rTMS as a treatment for MDD in the setting of New Zealand healthcare systems.
This was a naturalistic, open-label pilot study in which 30 patients with moderate-to-severe treatment-resistant MDD were treated with a course of rTMS (10 Hz) daily over the left dorsolateral prefrontal cortex for four weeks (20 sessions). Primary endpoint was response to treatment, stratified into non-responder, partial responder or responder based on the Montgomery-Asberg Depression Rating Scale (MADRS) at the end of treatment compared to baseline (<25% reduction, 25-50% reduction, and >50% reduction respectively). Participant remission was also noted as reaching a score of <=10.
Thirty participants completed the full course of treatment (16 women, mean age 47y, range 19-77y), with a mean baseline MADRS of 32.0 (range 21-48). Twelve participants were classified as responders, six as partial responders, and 12 as non-responders. Of the responders, nine were in remission at the end of treatment. Minimal side effects were reported.
Daily sessions of rTMS were successfully administered and were effective in treatment-resistant MDD. The treatment was accessible and well tolerated by the majority of the study participants and should be made available to MDD patients in New Zealand as a treatment option. Impact of prior treatment on remission with intermittent theta burst versus high-frequency repetitive transcranial magnetic stimulation in treatment resistant depression.