rTMS research & results

rTMS or magnetic brain stimulation is a new method of treatment for depression and appears to be a good alternative to antidepressants. After more than 20 years of research and practical experience, this treatment shows very good effects with hardly any side effects. Transcranial magnetic brain stimulation (rTMS) is part of a new development in which the treatment of psychiatric disorders is increasingly applied, localized and personalized. It is also called neuromodulation. Besides rTMS this new movement in healthcare also includes Deep brain stimulation and EEG Biofeedback/Neurofeedback​, namely Neuromodulation and Personalized Medicine​. The goal of personalized medicine is to achieve higher effective treatments with fewer side effects. 

In December 2007 the results of a large controlled study on the effects of rTMS treatment for depression were published. In this study, more than 300 depressed patients were treated with rTMS (O'Reardon et al, 2007). This study showed that rTMS is a safe and effective treatment for depressed patients who do not respond to antidepressants. Recently, this study was independently replicated in a multicentre study by George et al (2010). Both studies involved patients who had not responded to antidepressants and had a high degree of treatment resistance. Recently, Dennis Schutter (University of Utrecht) published a meta-analysis in which he concludes that rTMS in depression is better than sham stimulation (fake treatment), and moreover the effect of rTMS is at least comparable to antidepressant medications (Schutter, 2009: "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 the comparable to at least a subset of Commercially available antidepressant drug agents ...").

neuroCare clinics (formerly Brainclinics) combines rTMS treatment with psychotherapy. A recent study of over 90 patients  in the leading scientific journal ‘Brain Stimulation’ shows that the treatment method at neuroCare clinics combining rTMS and counseling has an efficacy of 78% and that on average 21 sessions are needed (Arns, Drinkenburg, Fitzgerald & Kenemans, 2012) . A summary of this study can be found here. Furthermore, during these sessions were no serious adverse events were reported

By comparison, antidepressants such as citalopram show remission in up to 33% of patients (Trivedie et al, 2006; STAR * D trial) and only 30-50% of the patients respond well to antidepressant medication.

From an initial cohort of 49 patients the long term effects of rTMS are mapped by a follow-up after 6 months. 36 of the 49 patients who underwent the treatment (73.5%) and were approached after six months. Of these 36 patients, 17 could still be regarded as responders, 9 patients showed a relapse and 1 patient was still on maintenance sessions. Another 9 patients did not respond or did not cooperate. These results are an optimistic estimate of efficacy after 6 months of 65% and a worst-case estimate of 47% (this is when all 9 patients who did not respond/cooperate are considered as ‘non-responders’). See chart below with the BDI scores of these sub-group of responders with follow-up data. After 6 months, the group as a whole has a more than 52% decrease in BDI compared to intake.

The combination of rTMS and counseling seems to have a long term effect for the majority of patients. 


In the figure above, the most recent results show the rTMS treatment in a subgroup of depressed clients (responders) whose follow-up data are also known. These patients were treated with rTMS in combination with cognitive therapy. The graph shows the Beck's Depression Inventory (BDI) score again, which is commonly used to measure of the severity of depression. This survey is conducted every 5 sessions to determine whether the therapy is effective or not. The cut-off score of the BDI, a score of 14. A score below 14 indicates that there is no more depression. 

Literature:

Arns, M., Drinkenburg, W. H. I. M., Fitzgerald, P. B., & Kenemans, J. L. (2012). Neurophysiological predictors of treatment outcome to rtms in depression. Brain Stimulation.

Arns, M. (2011). Personalized medicine in ADHD and depression: A quest for EEG treatment predictors. PhD thesis, Utrecht University.

Spronk, D. & Arns, M. (2009). rTMS bij depressie. Tijdschrift Voor Neuropsychiatrie & Gedragsneurologie, (Juli-Augustus).

George, M. S., Lisanby, S. H., Avery, D., McDonald, W. M., Durkalski, V., Pavlicova, M., . . . Sackeim, H. A. (2010). Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: A sham-controlled randomized trial. Archives of General Psychiatry, 67(5), 507-16. doi:10.1001/archgenpsychiatry.2010.46

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.​