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Improvement in Quality of Life With Left Prefrontal Transcranial Magnetic Stimulation in Patients With Pharmacoresistant Major Depression: Acute and Six Month Outcomes

Published:November 06, 2013DOI:https://doi.org/10.1016/j.brs.2013.10.008

      Abstract

      Background

      Transcranial magnetic stimulation (TMS) is a safe and effective treatment for major depression. We describe quality of life (QOL) outcomes from acute treatment with TMS, and describe the durability of benefit across 24-weeks.

      Methods

      Three hundred and one medication-free patients with pharmacoresistant major depression were randomized to active or sham TMS in a 6-week controlled trial. Nonresponders to the 6-week blinded phase of the study were enrolled in a 6-week open-label study without unblinding the prior treatment assignment. Responders and partial responders to both the blinded (active or sham treatment) or open acute treatment phases were tapered off TMS over three weeks, while initiating maintenance antidepressant medication monotherapy. These subjects entered the 24-week study to examine the durability of response to TMS. The Medical Outcomes Study-36 Item Short Form (SF-36) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to measure overall function and QOL. During the 24-week durability of effect study, QOL assessments were done at study entry and at the end of 24-weeks.

      Results

      Statistically significant improvement in both functional status and QOL outcomes was observed in patients treated with active TMS compared with sham TMS during the acute phase of the randomized, sham-controlled trial. Similar benefits were observed in patients who entered the open-label extension study. These improvements were sustained across the 24-week follow up study.

      Conclusions

      Acute treatment with TMS improved functional status and QOL outcomes in patients with major depression. This clinical effect was durable in long-term follow up.

      Keywords

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      References

        • World Health Organization [Internet]
        Global health risks: mortality and burden of disease attributable to selected major risks; p8.
        2009 (Available from:) (Cited 2013 May 8)
        • World Health Organization
        Fact Sheet No. 369.
        2012
        • Paykel E.S.
        • Weissman M.
        • Prusoff B.A.
        • Tonks C.M.
        Dimensions of social adjustment in depressed women.
        J Nerv Ment Dis. 1971; 152: 158-172
        • Weissman M.M.
        • Klerman G.L.
        • Paykel E.S.
        • Prusoff B.
        • Hanson B.
        Treatment effects on the social adjustment of depressed patients.
        Arch Gen Psychiatry. 1974; 30: 771-778
        • Williams Jr., J.W.
        • Kerber C.A.
        • Mulrow C.D.
        • Medina A.
        • Aguilar C.
        Depressive disorders in primary care: prevalence, functional disability, and identification.
        J Gen Intern Med. 1995; 10: 7-12
        • Keitner G.I.
        • Ryan C.E.
        • Miller I.W.
        Role of the family in recovery and major depression.
        Am J Psychiatry. 1995; 152: 1002-1008
        • Geerlings S.W.
        • Beekman A.T.F.
        • Deeg J.H.
        • Twisk J.W.R.
        • VanTilburg W.
        Duration and severity of depression predict mortality in older adults in the community.
        Psychol Med. 2002; 32: 609-618
        • McMahon E.M.
        • Buszewicz M.
        • Griffin M.
        • Beecham J.
        • Bonin E-V.
        • Rost F.
        • et al.
        Chronic and recurrent depression in primary care: socio-demographic features, morbidity, and costs.
        Int J Fam Med. 2012; (Article ID 316409)
        • Zivin K.
        • Ilgen M.A.
        • Pfeiffer P.N.
        • Welsh D.E.
        • McCarthy J.
        • Valenstein M.
        • et al.
        Early mortality and years of potential life lost among veterans affairs patients with depression.
        Psychiatr Serv. 2012; 63: 823-826
        • Wells K.
        • Stewart A.
        • Hays R.
        • Burnam A.
        • Rogers W.
        • Daniels M.
        • et al.
        The functioning and well-being of patients depressed: results from the medical outcomes study.
        JAMA. 1989; 262: 914-919
        • McCall W.V.
        • Cohen W.
        • Reboussin B.
        • Lawton P.
        Effects of mood and age on quality of life in depressed inpatients.
        J Affect Disord. 1999; 55: 107-114
        • Dunner D.L.
        • Rush A.J.
        • Russell J.M.
        • Burke M.
        • Woodard S.
        • Wingard P.
        • et al.
        Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression.
        J Clin Psychiatry. 2006; 67: 688-695
        • Solomon D.A.
        • Leon A.C.
        • Endicott J.
        • Mueller T.I.
        • Coryell W.
        • Shea M.T.
        • et al.
        Psychosocial impairment and recurrence of major depression.
        Compr Psychiatry. 2004; 45: 423-430
        • Solomon D.A.
        • Leon A.C.
        • Coryell W.
        • Mueller T.I.
        • Posternak M.
        • Endicott J.
        • et al.
        Predicting recovery from episodes of major depression.
        J Affect Disord. 2008; 107: 285-291
        • Wisniewski S.R.
        • Rush A.J.
        • Bryan C.
        • Shelton R.
        • Trivedi M.H.
        • Marcus S.
        • et al.
        Comparison of quality of life measures in a depressed population.
        J Nerv Ment Dis. 2007; 195: 219-225
        • Kennedy N.
        • Foy K.
        • Sherazi R.
        • McDonough M.
        • McKeon P.
        Long-term social functioning after depression treated by psychiatrists: a review.
        Bipolar Disord. 2007; 9: 25-37
        • Bech P.
        Social functioning: should it become an endpoint in trials of antidepressants?.
        CNS Drugs. 2005; 19: 313-324
        • Rosenquist P.B.
        • Brenes G.B.
        • Arnold E.M.
        • Kimball J.K.
        • McCall V.
        Health-related quality of life and the practice of electroconvulsive therapy.
        J ECT. 2006; 22: 18-24
        • McCall W.V.
        • Reboussin D.
        • Prudic J.
        • Haskett R.F.
        • Isenberg K.
        • Olfson M.
        • et al.
        Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT.
        J Affect Disord. 2013; 147: 107-111
        • O'Reardon J.P.
        • Solvason H.B.
        • Janicak P.G.
        • Sampson S.
        • Isenberg K.E.
        • Nahas Z.
        • et al.
        Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial.
        Biol Psychiatry. 2007; 62: 1208-1216
        • George M.S.
        • Lisanby S.H.
        • Avery D.
        • McDonald W.M.
        • Durkalski V.
        • Pavlicova M.
        • et al.
        Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial.
        Arch Gen Psychiatry. 2010; 67: 507-516
        • Demitrack M.A.
        • Thase M.E.
        Clinical significance of transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant depression: synthesis of recent data.
        Psychopharmacol Bull. 2009; 42: 5-38
        • Schutter D.J.L.G.
        Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis.
        Psychol Med. 2009; 39: 65-75
        • Slotema C.W.
        • Blom J.D.
        • Hoek H.W.
        • Sommer I.E.C.
        Should we expand the toolbox of psychiatric treatment methods to include repetitive transcranial magnetic stimulation (rTMS)? A meta-analysis of the efficacy of rTMS in psychiatric disorders.
        J Clin Psychiatry. 2010; 71: 873-884
        • Janicak P.G.
        • Nahas Z.
        • Lisanby S.H.
        • Solvason H.B.
        • Sampson S.M.
        • McDonald W.M.
        • et al.
        Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study.
        Brain Stimul. 2010; 3: 187-199
        • Avery D.H.
        • Isenberg K.E.
        • Sampson S.M.
        • Janicak P.G.
        • Lisanby S.H.
        • Maxiner D.F.
        • et al.
        Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial.
        J Clin Psychiatry. 2008; 69: 441-451
        • Ventura J.
        • Liberman R.P.
        • Green M.F.
        • Shaner A.
        • Mintz J.
        Training and quality assurance with the structured clinical interview for DSM-IV (SCID-I/P).
        Psychiatry Res. 1998; 79: 163-167
        • Sackeim H.A.
        The definition and meaning of treatment-resistant depression.
        J Clin Psychiatry. 2001; 16: 10-17
        • Ware Jr., J.E.
        • Bayliss M.S.
        • McHorney C.A.
        • Rogers W.H.
        • Razcek A.
        • et al.
        Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: summary of results from the medical outcomes study.
        Med Care. 1995; : AS264-AS279
        • Endicott J.
        • Nee J.
        • Harrison W.
        • Blumenthal R.
        Quality of life enjoyment and satisfaction questionnaire: a new measure.
        Psychopharmacol Bull. 1993; 29: 321-326
        • Kraemer H.C.
        • Kupfer D.J.
        Size of treatment effects and their importance to clinical research and practice.
        Biol Psychiatry. 2006; 59: 990-996
        • Turner E.H.
        • Matthews A.M.
        • Linardatos E.L.
        • Tell R.A.
        • Rosenthal R.
        Selective publication of antidepressant trials and its influence on apparent efficacy.
        N Engl J Med. 2008; 358: 252-260
        • McCall W.V.
        • Prudic J.
        • Olfson M.
        • Sackeim H.
        Health-related quality of life following ECT in a large community sample.
        J Affective Disord. 2006; 90: 269-274
        • Schosser A.
        • Serretti A.
        • Souery D.
        • Mendlewicz J.
        • Zohar J.
        • Montgomery S.
        • et al.
        European Group for the Study of Resistant Depression (GSRD) – where have we gone so far: review of clinical and genetic findings.
        Eur Neuropsychopharmacol. 2012 Jul; 22: 453-468
        • Brown C.
        • Schulberg H.C.
        • Shear M.K.
        Phenomenology and severity of depression and comorbid lifetime anxiety disorders in primary medical care practice.
        Anxiety. 1996; 2: 210-218
        • Judd L.L.
        Major depressive disorder: longitudinal symptomatic structure, relapse and recovery.
        Acta Psychiatr Scand. 2001; 104: 81-83
        • Greden J.F.
        The burden of disease for treatment-resistant depression.
        J Clin Psychiatry. 2001; 62: 26-31
        • Judd L.L.
        • Akiskal H.S.
        • Zeller P.J.
        • Paulus M.
        • Leon A.C.
        • Maser J.D.
        • et al.
        Psychosocial disability during the long-term course of unipolar major depressive disorder.
        Arch Gen Psychiatry. 2000; 57: 375-380
        • Saarijärvi S.
        • Salminen J.K.
        • Toikka T.
        • Raitasalo R.
        Health-related quality of life among patients with major depression.
        Nord J Psychiatry. 2002; 56: 261-264
        • Ishak W.W.
        • Ha K.
        • Kapitansky N.
        • Bagot K.
        • Jeffry J.
        • Fathy H.
        • et al.
        The impact of psychotherapy, pharmacotherapy, and their combination on quality of life in depression.
        Harv Rev Psychiatry. 2011; 19: 277-289
        • Judd L.L.
        • Paulus M.P.
        • Wells K.B.
        • Rappaport M.H.
        Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population.
        Am J Psychiatry. 1996; 153: 1411-1417
        • Post R.M.
        • Roy-Byrne P.P.
        • Uhde T.W.
        Graphic representation of the life course of illness in patients with affective disorder.
        Am J Psychiatry. 1988; 145: 844-848
        • Hirschfeld R.M.
        • Klerman G.L.
        • Andreasen N.C.
        • Clayton P.J.
        • Keller M.B.
        Psycho-social predictors of chronicity in depressed patients.
        Br J Psychiatry. 1986; 148: 648-654
        • Melartin T.K.
        • Rystala H.J.
        • Leskela U.S.
        • Lestela-Mielonen P.S.
        • Sokero T.P.
        • Isometsa E.T.
        • et al.
        Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder.
        J Clin Psychiatry. 2004; 65: 810-819
        • ten Doesschate M.C.
        • Koeter M.W.
        • Claudi L.H.
        • Bockting C.L.
        • Schene A.H.
        • The DELTA Study Group
        Health related quality of life in recurrent depression: a comparison with a general population sample.
        J Affect Disord. 2010; 120: 126-132
        • Shih J.H.
        • Ebert N.K.
        Understanding the impact of prior depression on stress generation: examining the roles of current depressive symptoms and interpersonal behavior.
        Br J Psychol. 2008; 990: 413-426
        • Fredman L.
        • Weissman M.M.
        • Leaf P.I.
        • Bruce M.L.
        Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic Catchment Area Study.
        J Affect Disord. 1988; 15: 103-112
        • Zlotnick C.
        • Kohn R.
        • Keitner G.
        The relationship between quality of interpersonal relationships and major depressive disorder: findings from the National Comorbidity Survey.
        J Affect Disord. 2000; 59: 205-215
        • Ishak W.W.
        • Greenberg J.M.
        • Balayan K.
        • Kapitansky N.
        • Jeffry J.
        • Fathy H.
        • et al.
        Quality of life: the ultimate outcome measure of interventions in major depressive disorder.
        Harv Rev Psychiatry. 2011; 19: 229-239