Depression

Transcranial magnetic stimulation in the treatment of depression. High-frequency, repetitive transcranial magnetic stimulation treatment to be an effective, side-effect free therapy for depression. It may hold promise for treating related psychiatric disorders as well.


There is good reason to believe the pineal gland is a magnetosensitive system and that application of magnetic fields has a similar effect to that of acute exposure to light with respect to melatonin secretion.Researchers propose that magnetic treatment could be a beneficial new therapy for winter depression in humans.

The effects of millimeter wave (MW) therapy as a supplemental treatment in patients suffering from various types of depression. MW therapy involved the use of a "Yav'-1" apparatus (5.6 mm wavelength, 53 GHz), and consisted of up to 60 minutes of exposure per day, 2 to 3 times per week, for a total of as many as 15 exposures. Results showed that combined MW/conventional treatment produced a complete recovery in over 50 percent of cases studied, a significant improvement in 41 percent, and some improvement in 8 percent.

M.T. Kirkcaldie, et al., Transcranial Magnetic Stimulation as Therapy for Depression and Other Disorders," R. Sandyk, et al., "Magnetic Felds and Seasonality of Affective Illness: Implications for Therapy,"

Combining high and low frequencies in rTMS antidepressive treatment: preliminary results.

Conca A, Di Pauli J, Beraus W, Hausmann A, Peschina W, Schneider H, Konig P, Hinterhuber H.

Departments of Psychiatry I and II, Regional Hospital, 6830 Rankweil, Austria. andreas.conca@lkhr.at

The antidepressive potency of repetitive transcranial magnetic stimulation (rTMS) seems to depend on variables such as the stimulation placements, different frequencies, stimulus intensities, coil shape and interstimulus intervals. The aim of this pilot study was to investigate the augmentation properties of rTMS combining low and high frequencies. Thirty six depressed medicated in-patients were recruited and assigned to three different rTMS treatment modalities as an add-on strategy (each n = 12). In group 1 a stimulus intensity of 110% of the motor threshold (MT) was used with a frequency of 10 Hz over the left dorsolatero prefrontal cortex (DLPC). The right DLPC was stimulated in the same session with 110% MT at 1 Hz. In group 2 the patients were stimulated only over the left DLPC with alternating trains of 110% MT at 10 Hz and trains of 110% MT at 1 Hz in the same session. In group 3 the high frequency stimulation over the left DLPC was performed as an internal control group. None of the treatment modalities was superior but different side effects were observed. These preliminary findings suggest that rTMS, at varying frequencies and stimulation placements, evokes different psychoactive effects of clinical relevance. Copyright 2002 John Wiley & Sons, Ltd.

Publication Types:
Clinical Trial

PMID: 12415555 [PubMed - indexed for MEDLINE]

Repetitive transcranial magnetic stimulation increases the release of dopamine in the mesolimbic and mesostriatal system.

Keck ME, Welt T, Muller MB, Erhardt A, Ohl F, Toschi N, Holsboer F, Sillaber I.

Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804, Munich, Germany. keck@mpipsykl.mpg.de

Repetitive transcranial magnetic stimulation (rTMS) is suggested to be a potentially useful treatment in major depression. In order to optimize rTMS for therapeutic use, it is necessary to understand the neurobiological mechanisms involved, particularly the nature of the neurochemical changes induced. Using intracerebral microdialysis in urethane-anesthetized and conscious adult male Wistar rats, we monitored the effects of acute rTMS (20 Hz) on the intrahippocampal, intraaccumbal and intrastriatal release patterns of dopamine and its metabolites (homovanillic acid, 3,4-dihydroxyphenylacetic acid). The stimulation parameters were adjusted according to the results of accurate MRI-based computer-assisted reconstructions of the current density distributions induced by rTMS in the rat brain, ensuring stimulation of frontal brain regions. In the dorsal hippocampus, the shell of the nucleus accumbens and the dorsal striatum the extracellular concentration of dopamine was significantly elevated in response to rTMS. Taken together, these data provide the first in vivo evidence that acute rTMS of frontal brain regions has a modulatory effect on both the mesolimbic and the mesostriatal dopaminergic systems. This increase in dopaminergic neurotransmission may contribute to the beneficial effects of rTMS in the treatment of affective disorders and Parkinson's disease.

PMID: 12213264 [PubMed - indexed for MEDLINE]

Improved executive functioning following repetitive transcranial magnetic stimulation.

Moser DJ, Jorge RE, Manes F, Paradiso S, Benjamin ML, Robinson RG.

Department of Psychiatry, University of Iowa College of Medicine, Iowa City, IA 52240, USA. David.Moser@uiowa.edu

The cognitive effects of active and sham repetitive transcranial magnetic stimulation (rTMS) were examined in 19 middle-aged and elderly patients with refractory depression. Patients received either active (n = 9) or sham (n = 10) rTMS targeted at the anterior portion of the left middle frontal gyrus. Patients in the active rTMS group improved significantly on a test of cognitive flexibility and conceptual tracking (Trail Making Test-B).

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 11971103 [PubMed - indexed for MEDLINE]

Transcranial magnetic stimulation in depression]

[Article in French]

Saba G, Januel D, Glikman J.

Psychiatre, assistant, Unite de Recherche clinique, Secteur III, Service du docteur Glikman, EPS de Ville Evrard, 5, rue du Docteur Delafontaine, 93200 Saint-Denis, France.

Among the new therapeutic techniques in psychiatry, transcranial magnetic stimulation (TMS) seems to bring a profit in the treatment of depressions. It uses the principle of inductance to generate a magnetic current, which in turn activates cortical neurons. Stimulation is highly focused and interests specific regions of the cerebral cortex. This therapeutic technique is generally well tolerated. Side effects are rare, the most hampering one is epileptic seizures. It is favored by high frequencies (above 5 Hz) and arises mainly with patients having a history of personal or family epileptic seizures. The first open trials, quickly confirmed by controlled studies showed the efficiency of TMS in depression. With depression, double blind randomized trials, using high frequencies, stimulation of the left dorsolateral prefrontal cortex give positive results with significant decrease of scores on depressive scales applied to resistant and non resistant depressions. Some studies have stimulated the right dorsolateral prefrontal cortex using low frequencies. The decrease of scores is also significant on depressive scales. The modulating effect of rTMS on cortical excitability of the brain justifies this distinction between high and low frequencies, high frequencies having a facilitating effect whereas low frequencies have an inhibitory effect.

Publication Types:
Review
Review, Tutorial

PMID: 11972144 [PubMed - indexed for MEDLINE]


A meta-analysis of repetitive transcranial magnetic stimulation in the treatment of depression.

Holtzheimer PE 3rd, Russo J, Avery DH.

Psychopharmacol Bull. 2001 Autumn;35(4):149-69. Related Articles, Links


Erratum in:
Psychopharmacol Bull. 2003 Spring;37(2):5.

Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Harborview Medical Center, 325 Ninth Avenue, Box 359896, Seattle, WA 98104, USA.

Repetitive transcranial magnetic stimulation (rTMS) is an emerging potential treatment for depression, but the data supporting its efficacy have not been systematically reviewed. The purpose of this study was to conduct a meta-analysis of rTMS trials in the treatment of depression. A search for all published and unpublished sham-controlled studies of left or right prefrontal cortical rTMS in the treatment of depression evaluated by the Hamilton Depression Rating Scale (HDRS) was conducted using no language restrictions. Fixed- and random-effects meta-analyses were performed on 12 studies comparing the decrease in HDRS scores achieved with rTMS and sham stimulation. Initial results with a fixed-effects analysis failed homogeneity testing; thus, a random-effects analysis was used to calculate all results. In 12 studies (16 individual effect sizes), the weighted mean effect size was 0.81 (95% CI: 0.42-1.20, P < .001). For studies using left dorsolateral pre-frontal cortex (DLPFC) stimulation (11 studies, 14 effect sizes), the weighted mean effect size was 0.89 (95% CI: 0.44-1.35, P < .001). For studies using left DLPFC stimulation in a parallel-groups design (seven studies, nine effect sizes), the weighted mean effect size was 0.88 (95% CI: 0.22-1.54, P < .01). No study showed a mean decrease in HDRS scores of > 50%, and the number of responders to rTMS (defined as a > 50% decrease in HDRS scores) across studies was relatively small (13.7% with rTMS versus 7.9% with sham stimulation). rTMS is statistically superior to sham stimulation in the treatment of depression, showing a moderate to large effect size. However, the clinical significance of these results is modest. The differences in response to rTMS across studies are not clearly explained, and, therefore, more research is needed.

Publication Types:
Meta-Analysis

 

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