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. 2019 May;9(5):e01275.
doi: 10.1002/brb3.1275. Epub 2019 Apr 2.

Concomitant medication use and clinical outcome of repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder

Aimee M Hunter  1   2 , Michael J Minzenberg  1   2 , Ian A Cook  1   2   3 , David E Krantz  1   2 , Jennifer G Levitt  1   2 , Natalie M Rotstein  2 , Shweta A Chawla  2 , Andrew F Leuchter  1   2
Affiliations

Concomitant medication use and clinical outcome of repetitive Transcranial Magnetic Stimulation (rTMS) treatment of Major Depressive Disorder

Aimee M Hunter et al. Brain Behav. 2019 May.

Abstract

Background: Repetitive Transcranial Magnetic Stimulation (rTMS) is commonly administered to Major Depressive Disorder (MDD) patients taking psychotropic medications, yet the effects on treatment outcomes remain unknown. We explored how concomitant medication use relates to clinical response to a standard course of rTMS.

Methods: Medications were tabulated for 181 MDD patients who underwent a six-week rTMS treatment course. All patients received 10 Hz rTMS administered to left dorsolateral prefrontal cortex (DLPFC), with 1 Hz administered to right DLPFC in patients with inadequate response to and/or intolerance of left-sided stimulation. Primary outcomes were change in Inventory of Depressive Symptomatology Self Report (IDS-SR30) total score after 2, 4, and 6 weeks.

Results: Use of benzodiazepines was associated with less improvement at week 2, whereas use of psychostimulants was associated with greater improvement at week 2 and across 6 weeks. These effects were significant controlling for baseline variables including age, overall symptom severity, and severity of anxiety symptoms. Response rates at week 6 were lower in benzodiazepine users versus non-users (16.4% vs. 35.5%, p = 0.008), and higher in psychostimulant users versus non-users (39.2% vs. 22.0%, p = 0.02).

Conclusions: Concomitant medication use may impact rTMS treatment outcome. While the differences reported here could be considered clinically significant, results were not corrected for multiple comparisons and findings should be replicated before clinicians incorporate the evidence into clinical practice. Prospective, hypothesis-based treatment studies will aid in determining causal relationships between medication treatments and outcome.

Keywords: Major Depressive Disorder; adrenergic; benzodiazepines; gamma-aminobutyric acid (GABA); psychostimulants; repetitive transcranial magnetic stimulation (rTMS); treatment outcome.

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Conflict of interest statement

Dr. Minzenberg owns stock in Elan Pharmaceuticals and has received investigator‐initiated support from Shire. Dr. Cook reports he has received research support from Covidien (formerly Aspect Medical Systems), National Institutes of Health, and NeoSync, Inc. within the past three years; he has been an advisor/consultant/reviewer for Arctica Health, Cerêve, HeartCloud, NeuroDetect, NeuroSigma, NIH (ITVA), U.S. Departments of Defense and Justice, and the VA (DSMB); he is editor of the Patient Management section of the American Psychiatric Association's FOCUS journal; his biomedical intellectual property is assigned to the Regents of the University of California, and he has stock options in NeuroSigma, where he has served as Chief Medical Officer (on leave); he is employed by the University of California, Los Angeles and also has an appointment as a Staff Psychiatrist, Neuromodulation and Mood Disorders programs, Greater Los Angeles Veterans Administration Health System. Dr. Krantz discloses that within the past 36 months he has received research support from the National Institutes of Health. He currently serves as an investigator on a study sponsored by Neosync, Inc. Dr. Leuchter discloses that within the past 36 months he has received research support from the National Institutes of Health, Neuronetics, Department of Defense, CHDI Foundation, and NeuroSigma, Inc. He has served as a consultant to NeoSync, Inc., Ionis Pharmaceuticals, Inc., and ElMindA. He is Chief Scientific Officer of Brain Biomarker Analytics LLC (BBA). Dr. Leuchter owns stock options in NeoSync, Inc. and has equity interest in BBA. Dr. Levitt, Dr. Hunter, Ms. Rotstein and Ms. Chawla do not have anything to disclose.

Figures

Figure 1
Figure 1
Data flow diagram of subject inclusion
Figure 2
Figure 2
Change in IDS total score (mean and standard deviation) at weeks 2, 4, 6 and rates of response and remission, for users versus non‐users of benzodiazepines (a) and psychostimulants (b)
See this image and copyright information in PMC

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