“
TITLE
5Hz Repetitive Transcranial Magnetic Stimulation for Post-Traumatic Stress Disorder Comorbid with Major Depressive Disorder
SOURCE
Journal of Affective Disorders. 235:414-420, 2018 08 01
BACKGROUND
Standard clinical protocols for repetitive transcranial magnetic stimulation (rTMS) for major depressive disorder (MDD) apply 10Hz pulses over left prefrontal cortex, yet little is known about the effects of rTMS in more diagnostically complex depressed patients.
OBJECTIVE / HYPOTHESIS
Post-traumatic stress disorder (PTSD) is commonly comorbid with MDD, and while rTMS has been shown to alleviate PTSD symptoms in preliminary studies, ideal parameters remain unclear. We conducted a prospective, open-label study of 5Hz rTMS for patients with comorbid PTSD+MDD and hypothesized stimulation would reduce symptoms of both disorders.
METHODS
Outpatients (N=40) with PTSD+MDD and at least moderate global severity were enrolled. 5Hz rTMS included up to 40 daily sessions followed by a 5-session taper. Symptoms were measured using the PTSD Checklist (PCL-5) and Inventory of Depressive Symptomatology, Self-Report (IDS-SR). Baseline-to-endpoint changes were analyzed.
RESULTS
The intent-to-treat population included 35 participants. Stimulation significantly reduced PTSD symptoms (PCL-5 baseline mean+/-SD score 52.2+/-13.1 versus endpoint 34.0+/-21.6; p<.001); 23 patients (48.6%) met a pre-defined categorical PTSD response criteria. MDD symptoms also improved significantly (IDS-SR, baseline 47.8+/-11.9 to endpoint 30.9+/-18.9; p<.001); 15 patients (42.9%) demonstrated categorical response and 12 (34.3%) remitted. PTSD and MDD symptom change was highly correlated (r=0.91, p<.001).
LIMITATIONS
Unblinded single-arm study, with modest sample size.
CONCLUSION
Significant and clinically meaningful reductions in both MDD and PTSD symptoms were observed following stimulation. The preliminary efficacy of 5Hz rTMS for both symptom domains in patients with comorbid disorders supports future controlled studies.
”
