Yvonne Turnier-Shea

Comparison of unlimited numbers of rapid transcranial magnetic stimulation (rTMS) and ECT treatment sessions in major depressive episode

Repetitive transcranial magnetic stimulation (rTMS) is a new technology which holds promise as a treatment of psychiatric disorders. Most work to date has been on depression. Superiority to placebo has been indicated in three small blind studies. We compared the antidepressant effects of rTMS and ECT in 32 patients suffering major depressive episode (MDE) who had failed to respond to at least one course of medication. There was no limit to the number of treatment sessions which could be given and treatment was continued until remission occurred or response plateaued. A significant main effect for treatment type was found [Pillai trace = 0.248, F(3,28) = 3.076, p = 0.044; power = 0.656], reflecting an advantage for ECT patients on measures of depression overall, however, rTMS produced comparable results on a number of measures. Blind raters using the 17-item Hamilton Depression Rating Scale (HDRS) found the rate of remission (HDRS = ? 8) was the same (68.8%), and the percentage improvement over the course of treatment of 55.6% (rTMS) and 66.4% (ECT), while favouring ECT, was not significantly different. Significant differences were shown (p & 0.03) in percentage improvement on Beck Depression Inventory ratings (rTMS, 45.5%; ECT, 69.1%), but not for improvement in Visual Analogue ratings of mood (rTMS 42.3%; ECT, 57%). rTMS has antidepressant effects of useful proportions and further studies are indicated.

Cortical excitability of psychiatric disorders: reduced post-exercise facilitation in depression compared to schizophrenia and controls.

Objective: In normal subjects, motor evoked potentials (MEPs) produced by transcranial magnetic stimulation (TMS) from the motor cortex are increased after non-fatiguing exercise of hand muscles. This phenomenon is called post-exercise facilitation. This study aims to test the hypothesis that psychiatric syndromes (major depressive episode, schizophrenia) have different levels of post-exercise facilitation compared to controls. Methods: Patients with DSM-IV major depressive episode (six female, four male), schizophrenia (two female, nine male) and a control group (nine female, four male) participated. MEPs were elicited pre- and post-exercise from the contralateral abductor pollicis brevis by TMS over the primary motor cortex. Results: Post-exercise facilitation expressed as a percentage of baseline was 510% in controls, 110% in depression and 190% in schizophrenia. There were significant differences in patients with depression and schizophrenia compared to controls (p = 0.0001, p = 0.0008). Conclusions: Post-exercise facilitation was reduced in depression and schizophrenia, suggesting impaired cortical excitability in these disorders. Further studies may discriminate between the two groups.

Daily and spaced treatment with transcranial magnetic stimulation in major depression: a pilot study

Objective: Transcranial magnetic stimulation is an emerging treatment of treatmentresistant depression. Current protocols rely on daily treatments. This study was designed to determine whether the time period over which treatment is delivered is an important factor in efficacy. Method: Sixteen adult patients with treatment-resistant major depression were randomly assigned to one of the two treatment groups, both of which received 2 weeks of treatment. One group received daily treatment (10 treatments, on business days). The other group received three treatments in week one, and two treatments in week two (five treatments, on spaced business days). Mood was rated using the Hamilton Depression Rating Scale (HDRS) and a self-rated visual analogue scale. Response was defined as a 50% reduction in HDRS rating, and remission was defined as achieving an HDRS score of 8 or less. The groups were compared throughout the 2-week study period. Results: At entry, there were no demographic differences between the groups. Multivariate tests showed a significant main effect for time (Pillai trace = 0.76, F(4,56) = 8.56, p < 0.001, power = 0.99) reflecting the improvement in both measures of depression during treatment. There was no significant difference between the groups overall (Pillai trace = 0.25, F(2,13) = 2.12, p = 0.16, power = 0.36). Additionally, there was no significant interaction between time and treatment group (Pillai trace = 0.18, F(4,56) = 1.35, p = 0.26, power = 0.39) indicating that the significant improvement in depression over time was similar for both treatment groups. There were no significant differences in response and remission rates between the groups. Conclusion: The time period of treatment appeared to be an important outcome factor. This suggests that less than daily transcranial magnetic stimulation treatment may be a useful clinical alternative.

Postexercise facilitation appears durable in normal subjects.

Abstract Transcranial magnetic stimulation (TMS) was used to study the postexercise facilitation of 11 normal subjects on eight occasions. Between individuals, there was almost a sixfold difference in facilitation. The greatest positive percentage change for any individual was 61%, and the greatest negative percentage change was 51%. The results suggest that facilitation is a durable individual characteristic of normal subjects. Serial studies may therefore be indicated in monitoring individuals suffering relapsing conditions.

Comparison of Transcranial Magnetic Stimulation and Electroconvulsive Therapy in Depression

Repetitive trans cranial magnetic stimulation (rTMS) is a new technology that has an antidepressant effect superior to placebo in blind trials. Our group has demonstrated that rTMS can be safely applied concurrently with certain psychotropic medications, that it can normalize the abnormal dexamathasone suppression test response, that it can influence the facial expression in depression, and that it can be safely and usefully combined with electroconvulsive therapy (ECT). In this study we compared the antidepressant effects of rTMS and ECT in 32 patients suffering a major depressive episode (MDE). There was no limit to the number of treatment sessions that could be given, and treatment was continued until remission occurred or response plateaued. Blinded raters. applied the Hamilton Depression Rating Scale (HDRS). A significant main effect for treatment type was found [Pillai Trace = 0.248, F (3,28) = 3.076, P = 0.044; Power = 0.656], reflecting an advantage for ECT patients on measures of depression overall. However, no differences between the rTMS and ECT groups in HDRS scores were found at entry or exit to the study. Additionally, no significant differences between the groups in percentage HDRS improvement or remission rates were shown. The rTMS group experienced fewer side effects than the rTMS group.