Original scientific paper

EFFICACY, SAFETY AND TOLERABILITY OF AUGMENTATIVE rTMS IN TREATMENT OF MAJOR DEPRESSIVE DISORDER (MDD): A PROSPECTIVE COHORT STUDY IN CROATIA

Igor Filipcic orcid.org/0000-0002-3283-8786 ; Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
Zeljko Milovac ; Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
Strahimir Sucic ; Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
Tomislav Gajsak orcid.org/0000-0001-9555-1056 ; Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
Ivona Simunovic Filipcic orcid.org/0000-0002-3265-0046 ; Department of Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
Ena Ivezic ; Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
Vjekoslav Aljinovic ; Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
Ivana Orgulan ; Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
Sandra Zecevic Penic ; Psychiatric Hospital “Sveti Ivan”, Zagreb, Croatia
Zarko Bajic ; Biometrika Healthcare Research, Zagreb, Croatia

Abstract

Background: An increasing body of research suggest that repetitive Transcranial Magnetic Stimulation (rTMS) is effective and
safe treatment option for patients with major depressive disorder (MDD). The Psychiatric Hospital “Sveti Ivan“has the first TMS
laboratory with rTMS and deep TMS (dTMS) in Croatia. The objective of this study was to assess the efficacy, safety and tolerability
of augmentative rTMS treatment vs standard treatment in Croatian patients with major depressive disorder (MDD).
Subjects and methods: Total of 93 MDD patients were enrolled; 41 of them were treated by augmentative rTMS and 52 were
treated by standard (psychopharmacotherapy and psychotherapy) therapy only. We delivered rTMS to the left dorsolateral
prefrontal cortex at 120% motor threshold (10 Hz, 4-second train duration), 3000 pulses per session using a figure-eight coil,
minimum of 20 sessions during four weeks. Our key outcome was the change in Hamilton Depression Scale (HAM-D17) result from
baseline to 4th week. Our secondary outcomes were changes in Hamilton Anxiety (HAM-A) and WHOQOL-BREF scales.
Results: After four weeks the changes of HAM-D17 and HAM-A results were significantly different between the group of patients
treated by augmentative rTMS (48% and 53% decrease, respectively) and the group of patients treated by the standard therapy alone
(24% and 30% decrease) (P=0.004, P=0.007). Absolute benefit increase defined as the difference between rates of remission (HAMD17
≤7) in rTMS and control group was 33% (P=0.001). Number of patients needed to treat with rTMS in order to achieve
remission in one patient was NNT=3. In a group of patients treated with augmentative rTMS 21/41 (51%), and in control group
17/52 (33%) were responders (P=0.071).
Conclusions: It seems that augmentative treatment with rTMS is more effective on depression and anxiety symptoms than
standard therapy in MDD with equal safety and tolerability. Randomized, controlled studies are required to verify this finding.

Keywords

repetitive transcranial magnetic stimulation (rTMS); major depressive disorder (MDD); anxiety

Hrčak ID:

178599

URI

https://hrcak.srce.hr/178599

Publication date:

20.3.2017.

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