Optimized repetitive transcranial magnetic stimulation techniques for the treatment of major depression: A proof of concept study

Jean-Philippe Miron; Helena Voetterl; Linsay Fox; Molly Hyde; Farrokh Mansouri; Sinjin Dees; Ryan Zhou; Jack Sheen; Véronique Desbeaumes Jodoin; Arsalan Mir-Moghtadaei; Daniel M Blumberger; Zafiris J Daskalakis; Fidel Vila-Rodriguez; Jonathan Downar

doi:10.1016/j.psychres.2021.113790

Optimized repetitive transcranial magnetic stimulation techniques for the treatment of major depression: A proof of concept study

Psychiatry Res. 2021 Apr:298:113790. doi: 10.1016/j.psychres.2021.113790. Epub 2021 Feb 7.

Affiliations

¹ Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM) et Département de Psychiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada. Electronic address: jean-philippe.miron@umontreal.ca.
² Krembil Research Institute, University Health Network, Toronto, ON, Canada; Department of Cognitive Neuroscience, Maastricht University, Maastricht, Limburg, Netherland.
³ Krembil Research Institute, University Health Network, Toronto, ON, Canada.
⁴ Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Faculty of Engineering, McMaster University, Hamilton, ON, Canada.
⁶ Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche du CHUM (CRCHUM) et Département de Psychiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
⁷ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada.
⁸ Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Temerty Centre for Therapeutic Brain Intervention at the Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of California San Diego, San Diego, California, United States.
⁹ Non-Invasive Neurostimulation Therapies Laboratory, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
¹⁰ Krembil Research Institute, University Health Network, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

PMID: 33581379
DOI: 10.1016/j.psychres.2021.113790

Abstract

Although effective in major depressive disorder (MDD), repetitive transcranial magnetic stimulation (rTMS) is costly and complex, limiting accessibility. To address this, we tested the feasibility of novel rTMS techniques with cost-saving opportunities, such as an open-room setting, large non-focal parabolic coils, and custom-built coil arms. We employed a low-frequency (LF) 1 Hz stimulation protocol (360 pulses per session), delivered on the most affordable FDA-approved device. MDD participants received an initial accelerated rTMS course (arTMS) of 6 sessions/day over 5 days (30 total), followed by a tapering course of daily sessions (up to 25) to decrease the odds of relapse. The self-reported Beck Depression Inventory II (BDI-II) was used to measure severity of depression. Forty-eight (48) patients completed the arTMS course. No serious adverse events occurred, and all patients reported manageable pain levels. Response and remission rates were 35.4% and 27.1% on the BDI-II, respectively, at the end of the tapering course. Repeated measures ANOVA showed significant changes of BDI-II scores over time. Even though our protocol will require further improvements, some of the concepts we introduced here could help guide the design of future trials aiming at increasing accessibility to rTMS.

Trial registration: ClinicalTrials.gov NCT04376697.

Keywords: TMS; arTMS; pilot.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Depression
Depressive Disorder, Major* / therapy
Humans
Prefrontal Cortex
Proof of Concept Study
Transcranial Magnetic Stimulation
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT04376697