1. The Effects of Repetitive Transcranical Magnetic Stimulation Treatment on Major Depression
Qinpu He , and Dr. Zhong Zheng Ph. D
1
2
Centre College, West China Medical School of Sichuan University
1
Introduction
Many people suffer from major depression disorders
(MMD). Antidepressant treatment is ineffective for 30% of
MMD patients globally. While repetitive transcranical
magnetic stimulation (rTMS) has already be included into
the Practice Guideline For the Treatment of Patients With
Major Depressive Disorder (the Third Edition), the
therapeutic mechanisms of rTMS remains unclear. This
research compared a group of patients receiving both
antidepressant and rTMS treatment with another group
receiving just antidepressant treatment to study the effects
of treating MMD by rTMS.
Materials and methods
Participants: All patients of West China Medical
School that had relapse of MMD after stopping taking
antidepressant for 3 months. All patients have scored
no less than 17 in Hamilton Depression Scale
(HAMD). A total of 159 people were randomly
assigned into 2 groups. A group had 75 people (18
males and 62 females), B group had 84 people (25
males and 59females) and a comparison group C had
90 people (28 males and 62 females). There were no
significant difference among the demographic data of
the 3 groups and medicalization information of the 2
treatment groups.
2
The evoked potentials used to examine patients:
1. MMN: The machine will give a series of high frequency voices and a series of low frequency voices in unpredictable sequence. The test
does not require reactions. It tests how the brain process and classify stimulation information.
2. P50: This test adopts paired short voice stimulation model. The test does not require any reaction. Normally people will have lower
reactions to the second voice because our sensory gate can help us low down the possible disturbance. It is used to test the anti-interference
ability of sensory gating.
3. P300: This test adopts a series of high frequency and low frequency voices in unpredictable sequences. It requires the subject to press the
button every time they hear the high frequency voice. It is used to test patients’ abilities to complete assignment and their abilities of
controlling, processing and cognition.
4. CNV: This test will be composed of a series of low frequency and high frequency voices and light. The high frequency voices and the low
frequency voices are arranged in unpredictable frequency. The high frequency voice will be followed by light. The patient is required to press
the button every time he see the lights.
Conclusions
This research found that rTMS with antidepressant
treatment will result in a decrease in the HAMD scores and
the effective rate of rTMS with antidepressant treatment
after 2 and 10 weeks were significantly higher than that of
antidepressant treatment. This result suggests that
antidepressant combined with rTMS treatment are more
effective in treating MMD than just antidepressant
treatment. After 2 weeks’ of treatment, group A patients
had a reduction in their incubation period of MMN while
that of group B remains unchanged, which suggests that
rTMS can increase brain’s automatic processing speed and
auditory system’s automatic classification of novel
stimulations speed. The amplitude of S2-P50 and S2P50/S1-P50 decreased after rTMS treatment, which
suggests that rTMS with antidepressant can improve
patients’ ability to restrain unimportant information.
Results
Before the treatment, the HAMD scores of group A and group B does not differ significantly (P>0.05) ; After 10 weeks, the HAMD
scores of group A are lower than group B (P<0.001). Group A has an effective rate of 86.67% after 2 weeks and 72.00% after 10 weeks.
Group B has an effective rate of 7.14% after 2 weeks and 54.76% after 10 weeks. A groups have higher effective rates than B group.
After 10 weeks of treatment, A group has a reduction in incubation period of MMN (P<0.01) and the reduction of group A is bigger
than that of group B (P <0.001). But the incubation period of MMN of group A is still higher than that of group C after treatment.
Acknowledgemen
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Methods: 3 groups were given selective serotonin
reuptake inhibitor (SSRI). A group was given rTMS
treatment for 15 days. This research used Magnstim
Rapid2 instruments. Previous studies found MMD
patients have contrary asymmetry of motor cortex
excitability (MCE) compared to normal people. Their
left hemisphere has lower MCE while right
hemisphere has higher MCE. The rTMS of high
frequency greater than 5 HZ and lower frequency less
than 1 HZ can be used to stimulate left hemisphere
and right hemisphere to reduce depression and
anxiety, respectively.
Resources:
1. Cárdenas-Morales L, Nowak DA, Kammer T,et al. Mechanisms and applications of theta-burst rTMS on the human motor cortex. Brain Topogr,2010;22(4):294-306.
2. Isenberg K,Downs D, Pierce K, et al . Low frequency rTMS stimulation of the right frontal cortex is as effective as high frequency rTMS stimulation of the left frontal cortex for
antidepressant-free, treatment-resistant depressed patients. Ann Clin Psychiatry, 2005 ;17(3):153-159.
3. Garcia-Toro M, Salva J, Daumal J,et al. High (20-Hz) and low (1-Hz) frequency transcranial magnetic stimulation as adjuvant treatment in medication-resistant depression.
Psychiatry Res, 2006;146(1): 53–57.
4. Speer AM, Benson BE, Kimbrell TK, et al. Opposite effects of high and low frequency rTMS on mood in depressed patients: relationship to baseline cerebral activity on PET. J
Affect Disord ， 2009;115(3): 386–394.
Further information
Acknowledgements:
I would like to thank Professor Zhong
Zheng for guiding me through the whole
treatment preocess. I would like to
thank Professor Weston and Professor
Cusato for helping me check this poster.
While rTMS with antidepressant treatment can greatly
reduce patients’ HAMD scores, patients with rTMS
treatment still have MMN incubation period longer than
the comparison group. Future researches need to study how
can we apply rTMS and other treatments to more
effectively treat MMD patients that after treatment patients
will completely return to normal people.