Preliminary Results from a Randomized Sham-Controlled Trial of Augmentative Neuro-navigated Right-Dorsolateral Prefrontal Cortex Low-Frequency Repetitive Transcranial Magnetic Stimulation for Antidepressant Non-responding Bipolar Depression
Refereed conference paper presented and published in conference proceedings

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AbstractIntroduction - Depressive and anxiety symptoms in bipolar disorders respond poorly to antidepressants and mood stabilisers. Single-arm evidence showed >50% bipolar depressed patients responded to right DLPFC 1Hz Repetitive Transcranial Magnetic Stimulation (rTMS). We report preliminary results from a study aiming to determine the acute anti-depressive and anti-anxiety effectiveness of 3-week, 5 sessions/week of neuronavigated 1-Hz Right DLPFC rTMS for antidepressant non-responding bipolar depressed patients already on mood stabiliser.
Methods -12 subjects (bipolar I: n=6, bipolar II: n=6) on mood stabilisers and lacking response to at least 6 weeks of antidepressant treatment were randomly assigned to 15 daily sessions of active (n=7) (Neuronavigated (Brainsight, Rogue Research Inc), 1 Hz, 110% MT, 5 trains of 60 stimuli, total= 300 stimuli (Magstim Rapid2)) or sham (neuro-navigated, 1Hz, 5 trains of 60 stimuli, total =300 stimuli from sham coil) (n=5) rTMS. All had concurrent mood stabiliser drugs with no prescription changes during study period. The subjects and outcome assessors were blinded to allocation status. Primary outcomes: > 50% Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A) reduction by week 3. Secondary outcome: emergence of hypomanic episodes (SCID-I) by week 3.
Results - At week 3, 1 of the 7 receiving active rTMS vs 1 of 5 receiving sham rTMS showed > 50% reduction of MADRS scores at week 3, with no significant between-group difference (Likelihood Ratio 0.068, df=1, p=0.80). 3 of the 7 who had active rTMS and none who had sham rTMS showed >50% reduction of HAMA score by end of week 3 (Likelihood Ratio 3.94, df=1, p=0.047). Hypomanic episodes were found in 2 out of the 5 sham-control participants.
Discussion - The anti-anxiety effectiveness of neuro-navigated low-frequency rTMS appears promising but as for the effect on depressive symptoms, remains to be evaluated in bipolar depressed patients.
All Author(s) ListMak ADP, Chan SSM, Lam LCW, Chu WCW, Chan A, Leung CMC, Lee S
Name of Conference2nd International Brain Stimulation Conference
Start Date of Conference05/03/2017
End Date of Conference08/03/2017
Place of ConferenceBarcelona
Country/Region of ConferenceSpain
Proceedings TitleBrain Stimulation
Volume Number10
Issue Number2
PublisherElsevier B.V.
Pages378 - 379
LanguagesEnglish-United States
Keywordsbipolar depression, transcranial magnetic stimulation, dorsolateral prefrontal cortex, brain navigation

Last updated on 2020-25-11 at 01:15