Personalization of Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder According to the Existing Psychiatric Comorbidity

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Abstract

Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) are evidenced-based treatments for patients with major depressive disorder (MDD) who fail to respond to standard first-line therapies. However, although various TMS protocols have been proven to be clinically effective, the response rate varies across clinical applications due to the heterogeneity of real-world psychiatric comorbidities, such as generalized anxiety disorder, posttraumatic stress disorder, panic disorder, or substance use disorder, which are often observed in patients with MDD. Therefore, individualized treatment approaches are important to increase treatment response by assigning a given patient to the most optimal TMS treatment protocol based on his or her individual profile. This literature review summarizes different rTMS or TBS protocols that have been applied in researches investigating MDD patients with certain psychiatric comorbidities and discusses biomarkers that may be used to predict rTMS treatment response. Furthermore, we highlight the need for the validation of neuroimaging and electrophysiological biomarkers associated with rTMS treatment responses. Finally, we discuss on which directions future efforts should focus for developing the personalization of the treatment of depression with rTMS or iTBS.

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Most cited references 106

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Theta burst stimulation of the human motor cortex.

Ying-Zu Huang, Mark J Edwards, Elisabeth Rounis … (2005)

It has been 30 years since the discovery that repeated electrical stimulation of neural pathways can lead to long-term potentiation in hippocampal slices. With its relevance to processes such as learning and memory, the technique has produced a vast literature on mechanisms of synaptic plasticity in animal models. To date, the most promising method for transferring these methods to humans is repetitive transcranial magnetic stimulation (rTMS), a noninvasive method of stimulating neural pathways in the brain of conscious subjects through the intact scalp. However, effects on synaptic plasticity reported are often weak, highly variable between individuals, and rarely last longer than 30 min. Here we describe a very rapid method of conditioning the human motor cortex using rTMS that produces a controllable, consistent, long-lasting, and powerful effect on motor cortex physiology and behavior after an application period of only 20-190 s.

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Posttraumatic stress disorder in the National Comorbidity Survey.

Ronald C Kessler (1995)

Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated life-time prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.

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Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018)

Jean-Pascal Lefaucheur, André Aleman, Chris Baeken … (2020)

A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Psychopharmacol Neurosci

Journal ID (iso-abbrev): Clin Psychopharmacol Neurosci

Title: Clinical Psychopharmacology and Neuroscience

Publisher: Korean College of Neuropsychopharmacology

ISSN (Print): 1738-1088

ISSN (Electronic): 2093-4327

Publication date (Print): 31 May 2021

Publication date (Electronic): 31 May 2021

Publication date PMC-release: 31 May 2021

Volume: 19

Issue: 2

Pages: 190-205

Affiliations

[1 ]Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu

[2 ]Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan

[3 ]Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan

[4 ]Taiwan Allied Clinics for Integrative TMS, Taipei, Taiwan

[5 ]Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan

[6 ]Department of Public Health & Medical Humanities, Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan

[7 ]Balance Psychiatric Clinic, Hsinchu, Taichung, Taiwan

[8 ]Ph.D. Program for Translational Medicine, College of Medicine, China Medical University, Taichung, Taiwan

[9 ]Department of Neurology, China Medical University Hospital, Taichung, Taiwan

[10 ]Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

[11 ]Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[12 ]Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

[13 ]Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

[14 ]Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

[15 ]Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan

[16 ]Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan

[17 ]Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands

[18 ]Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain Nerve Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands

[19 ]College of Medicine, China Medical University, Taichung, Taiwan

[20 ]Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan

[21 ]An-Nan Hospital, China Medical University, Tainan, Taiwan

Author notes

Address for correspondence: Kuan-Pin Su Department of Psychiatry, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan, E-mail: cobolsu@ 123456gmail.com , ORCID: https://orcid.org/0000-0002-4501-2502

[*]

These authors contributed equally to this study.

Author information

Po-Han Chou https://orcid.org/0000-0002-4148-457X

Yen-Feng Lin https://orcid.org/0000-0003-3017-6026

Ming-Kuei Lu https://orcid.org/0000-0002-2768-4399

Hsin-An Chang https://orcid.org/0000-0001-5572-7109

Che-Sheng Chu https://orcid.org/0000-0002-6911-1839

Wei Hung Chang https://orcid.org/0000-0002-5964-106X

Taishiro Kishimoto https://orcid.org/0000-0003-0557-8648

Alexander T. Sack https://orcid.org/0000-0002-1471-0885

Kuan-Pin Su https://orcid.org/0000-0002-4501-2502

Article

Publisher ID: cpn-19-2-190

DOI: 10.9758/cpn.2021.19.2.190

PMC ID: 8077054

PubMed ID: 33888649

SO-VID: c4e9cacb-da93-4451-8964-5c3a02310312

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This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Personalization of Repetitive Transcranial Magnetic Stimulation for the Treatment of Major Depressive Disorder According to the Existing Psychiatric Comorbidity

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Wiley: Novel Coronavirus COVID-19

Most cited references 106

Theta burst stimulation of the human motor cortex.

Posttraumatic stress disorder in the National Comorbidity Survey.

Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018)

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