rTMS or magnetic Brain stimulation is a new method to treat depression and has shown to be a good alternative to antidepressants. After more then 20 years of research and results from our clinic, this treatment seems very efficacious without adverse side effects. Transcranial Magnetic Stimulation (rTMS) is part of a new development in the treatment of psychiatric disorders, where more often treatments are more focal, localised and personalized. Besides rTMS other treatments such as Deep Brain Stimulation and EEG Biofeedback are also part of this new development; also referred to as Personalized Medicine. The primary goal of Personalized Medicine is to get the right treatment to the right person at the right time, leading to higher efficacies and fewer side effects. For more background information on Personalized Medicine also read our article in the Personalized Medicine section.
In December 2007 the results from a large-scale controlled study were published on the effects of rTMS treatment for depression in 300 patients. These were all treatment-resistive patients who did not respond to antidepressant medication. This study – published in Biological Psychiatry by O’Reardon and colleagues – demonstrated that rTMS is a safe and efficacious treatment for treatment resistive depression. Recently, Dennis Schutter (2008) from the University of Utrecht has published a meta-analysis where he concludes that rTMS in Depression is superior to sham and that the effects size is robust and comparable to at least a subset of commercially available antidepressant drug agents (Schutter, 2008: "These findings show that high-frequency rTMS over the left DLPFC is superior to sham in the treatment of depression. The effect size is robust and comparable to at least a subset of commercially available antidepressant drug agents...").
In the 3 Brainclinics clinics in The Netherlands rTMS is provided in a practical setting and combined with psychotherapy. In this setting any client with depression is treated (so not only treatment resistive patients). The rTMS treatment is personalized for every client using their individual Quantative EEG or QEEG on the basis of which the stimulation site and stimulation frequency is chosen. Furthermore, the EEG is used to rule out contra-indications – such as paroxysmal activity and the presence of focal-beta spindles. Recently, our first clinical results as well as pre- and post-QEEG changes after rTMS treatment have been published in the EEG and Clinical Neuroscience journal (Spronk et al., 2008) and these results have been prsented at several international scientific conferences such as the ISNR meeting in San Antonio (Tx, USA), the ECNS - ISNIP meeting in Frankfurt (Germany) and the IPEG meeting in Rouffach (France). The Powerpoints presentations of these talks can be found under 'Media and Events'
Download hier het persbericht: "Depressie goed te behandelen met Magnetische Hersenstimulatie (rTMS).
The figure below shows the results of depressive clients treated with QEEG based rTMS. The graph shows the Beck's Depression Inventory (BDI) score, which is a very often used questionnaire to assess the severity of depressive symptoms. This questionnaire was assessed every 5th session. The cut-off score is 13, so a score below 13 indicates the client is formally not depressed anymore. The graph below clearly shows that on average clients showed a ‘normal’ BDI score after 15 sessions.
The conclusions based on these 38 clients with Major Depressiev Disorder can summarized as follows:
1) The graph above shows the data for responders and non-responders. The response rate was 76% (>50% decrease in BDI score or full remission). Of these 29 patients, 28 showed full remission (no longer depressed).
2) Between intake and outtake there is an almost 80% reduction in depressive symptomatology (BDI score).
3) During these sessions no adverse side effects were reported.
4) Furthermore, patients who did not respond to ECT (electroconvulsive therapy) are more likely to not respond to rTMS as well.
In comparison, Antidepressants such as Citalopram show full remission in maximum 33% of patients (Trivedie et al., 2006; STAR*D trial) and only 30-50% of clients respond well to Antidepressant medication.
The graph belopw shows the first follow-up results from 5 clients followed-up after 6 months. This graph clearly shows that the antidepressive effect is maintained even after 6 months without treatment. The combination of rTMS and psychotherapy therefore seems to have long-term effects. This further demonstrates that the treatment effects reported above cannot be explained by placebo-effects, since placebo-effects usually dissapear within 6 months.
Literature:
Martijn Arns (2008) Personalized Medicine: Nieuwe ontwikkelingen in de diagnostiek en behandeling van Depressie en ADHD. De Psycholoog, september 2008.
Desiree Spronk, Martijn Arns, Aukje Bootsma, Rosalinde van Ruth & Paul Fitzgerald (2008)Long term effects of left frontal rTMS on EEG and ERP's in patients with Depression. EEG and Clinical Neuroscience, 39(3), 118-124.
Schutter (2008) Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychological Medicine, 1-11.
O'Reardon, J.P., Solvason, H.B., Janicak, P.G., Sampson, S., Isenberg, K.E., Nahas, Z., McDonald, W.M., Avery, D., Fitzgerald, P.B., Loo, C., Demitrack, M.A., George, M.S. & Sackeim (2007) Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial. Biological Psychiatry, 62: 1208-1216.
