Psychostimulant Use and Clinical Outcome of Repetitive Transcranial Magnetic Stimulation Treatment of Major Depressive Disorder

SOURCE: Depression & Anxiety. 39(5):397-406, 2022 May.

AUTHORS: Wilke SA; Johnson CL; Corlier J; Marder KG; Wilson AC; Pleman CM; Leuchter AF

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD). Psychostimulant medication use may be associated with improved rTMS outcomes, but a detailed understanding of these relationships is lacking.

METHODS: We compared MDD subjects taking psychostimulants (n = 37) with those not taking one of these medications (n = 53) during a course of 30 rTMS treatments. Changes in the 30-item Inventory of Depressive Symptomatology Self Report (IDS-SR30) subscale scores were examined at treatment 30. We also subdivided subjects into three categories based on drug mechanism and looked at IDS-SR30 total score after treatments 10, 20, and 30.

RESULTS: Subjects taking psychostimulants had a significantly greater overall clinical improvement than those not taking these medications at treatment 30. The psychostimulant group also improved significantly more than the control group in “”sleep”” and “”mood/cognition,”” but not “”anxiety/arousal”” IDS-SR30 subscales. No differences were detected among individual drug categories, which may reflect the limited sample size for individual medications. There was a negative dose-response relationship for the lisdexamfetamine/dextroamphetamine group, in which lower doses were associated with better clinical outcome.

CONCLUSIONS: Psychostimulant medications may enhance clinical efficacy of rTMS for MDD by preferentially impacting specific symptom domains. For some psychostimulants, these effects may be dose-dependent. Prospective clinical trials are needed to guide psychostimulant augmentation of brain stimulation therapies.