Three Weeks of rTMS Treatment Maintains Clinical Improvement But Not Electrophysiological Changes in Patients With Depression: A 6-Week Follow-Up Pilot Study.

Author: Choi KM1,2,3,4, Choi SH5, Lee SM2,3,4, Jang KI2,3,4, Chae JH2,3,4
1Institute for Brain and Cognitive Engineering, Korea University, Seoul, South Korea.
2Department of Psychiatry, Seoul St. Mary's Hospital, Seoul, South Korea.
3Institute of Biomedical Industry, Catholic University of Korea, College of Medicine, Seoul, South Korea.
4Department of Biomedicine & Health Sciences, Catholic University of Korea, College of Medicine, Seoul, South Korea.
5Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea.
Conference/Journal: Front Psychiatry.
Date published: 2019 Jun 7
Other: Volume ID: 10 , Pages: 351 , Special Notes: doi: 10.3389/fpsyt.2019.00351. eCollection 2019. , Word Count: 335

Our previous study demonstrated that 3 weeks of repetitive transcranial magnetic stimulation (rTMS) increases P200 amplitudes and improves the symptoms of depression and anxiety in depression patients. In the present study, we investigated whether 3 weeks of rTMS treatment maintained the P200 amplitude in patients with depression at 6 weeks of follow-up. We measured the 6-week maintenance effects of rTMS using clinical questionnaires and an auditory oddball paradigm. Twenty-one patients with medication-resistant major depression participated in this pilot study. All patients underwent rTMS treatment for 3 weeks; they completed clinical ratings and performed the auditory oddball task at the pre-treatment, post-treatment, and 6-week follow-up visit (3 weeks after finishing rTMS treatment). The results revealed an increase in P200 amplitudes as well as improvements in the symptoms of depression and anxiety by 3 weeks of rTMS treatment. Furthermore, the results demonstrated maintenance effects on clinical ratings at 6-week follow-up. Depression and anxiety scales showed improvements in post-treatment and maintenance effects at the 6-week follow-up. Although P200 amplitude showed a significant main effect for 3 time points (baseline, post-treatment, and 6-week follow-up visit), at 2 time point comparisons, P200 amplitudes significantly increased in post-treatment compared to those of the baseline condition but did not show the maintenance effects of long-term rTMS at the 6-week follow-up compared to those of the baseline condition (  p = .173, Bonferroni correction). Standardized low-resolution brain electromagnetic tomography (sLORETA) for P200 showed significant activation in the left middle frontal gyrus in post-treatment but no significant activation at the 6-week follow-up. Moreover, the amplitudes of overall topographic distribution were reduced at 6 weeks of follow-up. The 3 weeks of rTMS treatment induced the maintenance of the improvements in the symptoms of depression and anxiety. However, considering the results of the event-related potential (ERP) and sLORETA, 3 weeks of rTMS treatment may not be sufficient to maintain this improvement, implying that a treatment period of more than 3 weeks may be required to reveal the electrophysiological maintenance effect of rTMS.

KEYWORDS: depression; emotion regulation; event-related potential; maintenance effects; rTMS; standardized low-resolution brain electromagnetic tomography

PMID: 31231248 PMCID: PMC6566016 DOI: 10.3389/fpsyt.2019.00351