Synergistic use of deep TMS therapy with IV ketamine infusions for major depressive disorder: a pilot study.

OBJECTIVE: Major Depressive Disorder (MDD) is a pervasive psychiatric condition effecting approximately 21 million adults in the U.S. (8.4%). An estimated 30-60% of patients are resistant to traditional treatment approaches (medications and talk-therapy), alluding to the need for additional options. Two promising treatment modalities include transcranial magnetic stimulation (TMS) and ketamine infusions; both have shown efficacy in standalone studies but have scarcely been investigated synergistically in the same group of participants. METHOD: In the current study, 169 participants with treatment-resistant MDD received 36 treatments of Deep TMS-only (H1 + H7 protocols), while 66 received 36 treatments of Deep TMS (H1 + H7 protocols) and 6 IV infusions of ketamine over the course of 9 weeks. Depressive symptoms were compared pre- and -post treatment in both conditions using the PHQ-9. RESULTS: In both treatment groups, depressive symptoms were significantly reduced from pre-to-post and there were no significant differences in response between the TMS + ketamine condition and the TMS-only condition. The TMS + ketamine condition had an 80.30% response rate (53 out of 66) and 43.42% remission rate (28 out of 66) compared to a 76.92% response (130 out of 169) and 39.64% remission (67 out of 16) in the TMS-only condition. CONCLUSION: These results support the notion that TMS treatments yield high response rates in treatment-resistant cases; however, in this investigation there was no added benefit for including 6 sessions of IV ketamine in conjunction with TMS. Future investigations using randomized-control designs and robust outcome measures are warranted.

Deep transcranial magnetic stimulation alters resting-state neurophysiological traits in major depressive disorder.

OBJECTIVE: Major depressive disorder (MDD) is one of the most prevalent and debilitating health conditions worldwide; unfortunately, many patients do not respond to traditional antidepressant medication or talk therapy approaches. Deep transcranial magnetic stimulation (Deep TMS) has emerged as an effective treatment option for such "treatment-resistant" cases; however, the mechanisms by which Deep TMS attenuates depressive symptoms are still ambiguous. METHODS: In the current study, resting-state quantitative electroencephalography (QEEG) measures were assessed pre-and-post treatment to illustrate neurophysiological changes resulting from Deep TMS. RESULTS: The results showed reduced slow-frequency brain activity (delta and theta waves) in the prefrontal cortex following 36 treatments. Additionally, baseline QEEG measures predicted treatment response with 93 % accuracy. CONCLUSIONS: These findings provide preliminary evidence that TMS improves depressive symptoms by mitigating slow-wave brain activity in the prefrontal cortex. SIGNIFICANCE: Deep TMS paired with QEEG should continue to be utilized for treatment of MDD in clinical practice and future studies should explore its potential for other neuropsychiatric conditions.

The effects of deep transcranial magnetic stimulation on Alzheimer's disease: a case report examining cognitive functioning, memory, and QEEG.

Numerous treatment options are being studied for Alzheimer's disease (AD) given the rising prevalence of this condition worldwide. Transcranial Magnetic Stimulation (TMS) is a promising option for regulating specific neurological abnormalities pertaining to this condition. This case presents a patient with AD and co-occurring major depressive disorder that received 36 sessions of Deep TMS to the frontal and temporal lobes. This patient experienced improved general cognitive functioning and memory, remission from depression, and reduced slow-frequency theta activity in frontal and temporal sites. Following 7 months of weekly maintenance, additional improvements occurred. This report suggests that Deep TMS may be effective in mitigating AD symptoms, and maintenance sessions are advisable.