Antidepressant effectiveness of deep Transcranial Magnetic Stimulation (dTMS) in patients with Major Depressive Disorder (MDD) with or without Alcohol Use Disorders (AUDs): a 6-month, open label, follow-up study

Chiara Rapinesi; Martina Curto; Georgios D Kotzalidis; Antonio Del Casale; Daniele Serata; Vittoria Rachele Ferri; Simone Di Pietro; Paola Scatena; Francesco Saverio Bersani; Ruggero Nessim Raccah; Vittorio Digiacomantonio; Stefano Ferracuti; Giuseppe Bersani; Abraham Zangen; Gloria Angeletti; Paolo Girardi

doi:10.1016/j.jad.2014.11.015

Antidepressant effectiveness of deep Transcranial Magnetic Stimulation (dTMS) in patients with Major Depressive Disorder (MDD) with or without Alcohol Use Disorders (AUDs): a 6-month, open label, follow-up study

J Affect Disord. 2015 Mar 15:174:57-63. doi: 10.1016/j.jad.2014.11.015. Epub 2014 Nov 20.

Authors

Chiara Rapinesi¹, Martina Curto², Georgios D Kotzalidis³, Antonio Del Casale⁴, Daniele Serata¹, Vittoria Rachele Ferri¹, Simone Di Pietro⁵, Paola Scatena¹, Francesco Saverio Bersani⁶, Ruggero Nessim Raccah⁷, Vittorio Digiacomantonio⁸, Stefano Ferracuti⁵, Giuseppe Bersani⁹, Abraham Zangen¹⁰, Gloria Angeletti⁵, Paolo Girardi¹

Affiliations

¹ NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
² NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Bipolar & Psychotic Disorders Program, McLean Hospital, Belmont, MA, USA.
³ NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy. Electronic address: giorgio.kotzalidis@uniroma1.it.
⁴ NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Department of Psychiatric Rehabilitation, P. Alberto Mileno Onlus Foundation, Vasto, Italy.
⁵ NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy.
⁶ Department of Neurology and Psychiatry, Policlinico Umberto I University Hospital, Sapienza University, Rome, Italy.
⁷ ATID Ltd. Advanced Technology Innovation Distribution, Rome, Italy.
⁸ Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
⁹ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy.
¹⁰ Department of Life Sciences, Ben Gurion University of the Negev, Be׳er Sheva, Israel.

PMID: 25484178
DOI: 10.1016/j.jad.2014.11.015

Abstract

Introduction: Co-occurrence of Major Depressive (MDD) and Alcohol Use Disorders (AUDs) is frequent, causing more burden than each disorder separately. Since the dorsolateral prefrontal cortex (DLPFC) is critically involved in both mood and reward and dysfunctional in both conditions, we aimed to evaluate the effects of dTMS stimulation of bilateral DLPFC with left prevalence in patients with MDD with or without concomitant AUD.

Methods: Twelve MDD patients and 11 with concomitant MDD and AUD (MDD+AUD) received 20 dTMS sessions. Clinical status was assessed through the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impressions severity scale (CGIs), craving through the Obsessive Compulsive Drinking Scale (OCDS) in MDD+AUD, and functioning with the Global Assessment of Functioning (GAF).

Results: There were no significant differences between the two groups in sociodemographic (age, sex, years of education and duration of illness) and baseline clinical characteristics, including scores on assessment scales. Per cent drops on HDRS and CGIs scores at the end of the sessions were respectively 62.6% and 78.2% for MDD+AUD, and 55.2% and 67.1% for MDD (p<0.001). HDRS, CGIs and GAF scores remained significantly improved after the 6-month follow-up. HDRS scores dropped significantly earlier in MDD+AUD than in MDD LIMITATIONS: The small sample size and factors inherent to site and background treatment may have affected results.

Conclusions: High frequency bilateral DLPFC dTMS with left preference was well tolerated and effective in patients with MDD, with or without AUD. The antidepressant effect of dTMS is not affected by alcohol abuse in patients with depressive episodes. The potential use of dTMS for mood modulation as an adjunct to treatment in patients with a depressive episode, with or without alcohol abuse, deserves further investigation.

Keywords: Alcohol; Depression; Dorsolateral prefrontal cortex (DLPFC); deep Transcranial Magnetic Stimulation (dTMS).

Publication types

Clinical Trial

MeSH terms

Adult
Affect*
Alcohol Drinking
Alcoholism / complications*
Alcoholism / physiopathology
Depressive Disorder, Major / complications*
Depressive Disorder, Major / physiopathology
Depressive Disorder, Major / psychology
Depressive Disorder, Major / therapy*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Obsessive Behavior
Prefrontal Cortex / physiopathology*
Research Design
Severity of Illness Index
Transcranial Magnetic Stimulation* / methods
Treatment Outcome