Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial
<b>Background:</b> Treatment-resistant depression (TRD) is considered one of the major clinical challenges in the field of psychiatry. An estimated 44% of patients with major depressive disorder (MDD) do not respond to two consecutive antidepressant therapies, and 33% do not respond to u...
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MDPI AG
2023-02-01
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| Online Access: | https://www.mdpi.com/2076-3425/13/2/293 |
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| author | Medard Kofi Adu Reham Shalaby Ejemai Eboreime Adegboyega Sapara Mobolaji A. Lawal Corina Chew Shelley Daubert Liana Urichuck Shireen Surood Daniel Li Mark Snaterse Mike Mach Pierre Chue Andrew J. Greenshaw Vincent I. O. Agyapong |
| author_facet | Medard Kofi Adu Reham Shalaby Ejemai Eboreime Adegboyega Sapara Mobolaji A. Lawal Corina Chew Shelley Daubert Liana Urichuck Shireen Surood Daniel Li Mark Snaterse Mike Mach Pierre Chue Andrew J. Greenshaw Vincent I. O. Agyapong |
| author_sort | Medard Kofi Adu |
| collection | DOAJ |
| description | <b>Background:</b> Treatment-resistant depression (TRD) is considered one of the major clinical challenges in the field of psychiatry. An estimated 44% of patients with major depressive disorder (MDD) do not respond to two consecutive antidepressant therapies, and 33% do not respond to up to four antidepressants. Over 15% of all patients with MDD remain refractory to any treatment intervention. rTMS is considered a treatment option for patients with TRD. Likewise, iCBT is evidence-based, symptom-focused psychotherapy recommended for the treatment of TRD. <b>Objective:</b> This study aimed to evaluate the initial comparative clinical effectiveness of rTMS treatment with and without iCBT as an innovative intervention for the treatment of participants diagnosed with TRD. <b>Methods:</b> This study is a prospective two-arm randomized controlled trial. Overall, 78 participants diagnosed with TRD were randomized to one of two treatment interventions: rTMS sessions alone and rTMS sessions plus iCBT. Participants in each group were made to complete evaluation measures at baseline, and 6 weeks (discharge) from treatment. The primary outcome measure was baseline to six weeks change in mean score for the 17-item Hamilton depression rating scale (HAMD-17). Secondary outcomes included mean baseline to six-week changes in the Columbia suicide severity rating scale (CSSRS) for the rate of suicidal ideations, the QIDS-SR16 for subjective depression, and the EQ-5D-5L to assess the quality of health in participants. <b>Results:</b> A majority of the participants were females 50 (64.1%), aged ≥ 40 39 (50.0%), and had college/university education 54 (73.0%). After adjusting for the baseline scores, the study failed to find a significant difference in the changes in mean scores for participants from baseline to six weeks between the two interventions under study on the HAMD-17 scale: F (1, 53) = 0.15, <i>p</i> = 0.70, partial eta squared = 0.003, CSSRS; F (1, 56) = 0.04 <i>p</i> = 0.85, partial eta squared = 0.001, QIDS-SR16 scale; F (1, 53) = 0.04 <i>p</i> = 0.61, partial eta squared = 0.005, and EQ-5D-VAS; F (1, 51) = 0.46 <i>p</i> = 0.50, and partial eta squared = 0.009. However, there was a significant reduction in means scores at week six compared to baseline scores for the combined study population on the HAMD-17 scale (42%), CSSRS (41%), QIDS-SR16 scale (35%), and EQ-VAS scale (62%). <b>Conclusion:</b> This study did not find that combined treatment of TRD with rTMS + iCBT (unguided) was superior to treatment with rTMS alone. Our findings do not support the use of combined treatment of rTMS + iCBT for the management of TRD disorders. |
| first_indexed | 2024-03-11T09:03:55Z |
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| language | English |
| last_indexed | 2024-03-11T09:03:55Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-4dc4f4b378df47a8843421733ece46f62023-11-16T19:28:58ZengMDPI AGBrain Sciences2076-34252023-02-0113229310.3390/brainsci13020293Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot TrialMedard Kofi Adu0Reham Shalaby1Ejemai Eboreime2Adegboyega Sapara3Mobolaji A. Lawal4Corina Chew5Shelley Daubert6Liana Urichuck7Shireen Surood8Daniel Li9Mark Snaterse10Mike Mach11Pierre Chue12Andrew J. Greenshaw13Vincent I. O. Agyapong14Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, CanadaDepartment of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB T6G 2B7, CanadaDepartment of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB T6G 2B7, CanadaDepartment of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB T6G 2B7, CanadaDepartment of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB T6G 2B7, CanadaAlberta Health Services, Addiction, and Mental Health, Edmonton, AB T5J 3E4, CanadaAlberta Health Services, Addiction, and Mental Health, Edmonton, AB T5J 3E4, CanadaAlberta Health Services, Addiction, and Mental Health, Edmonton, AB T5J 3E4, CanadaAlberta Health Services, Addiction, and Mental Health, Edmonton, AB T5J 3E4, CanadaAlberta Health Services, Addiction, and Mental Health, Edmonton, AB T5J 3E4, CanadaAlberta Health Services, Addiction, and Mental Health, Edmonton, AB T5J 3E4, CanadaAlberta Health Services, Addiction, and Mental Health, Edmonton, AB T5J 3E4, CanadaDepartment of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB T6G 2B7, CanadaDepartment of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St NW, Edmonton, AB T6G 2B7, CanadaDepartment of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada<b>Background:</b> Treatment-resistant depression (TRD) is considered one of the major clinical challenges in the field of psychiatry. An estimated 44% of patients with major depressive disorder (MDD) do not respond to two consecutive antidepressant therapies, and 33% do not respond to up to four antidepressants. Over 15% of all patients with MDD remain refractory to any treatment intervention. rTMS is considered a treatment option for patients with TRD. Likewise, iCBT is evidence-based, symptom-focused psychotherapy recommended for the treatment of TRD. <b>Objective:</b> This study aimed to evaluate the initial comparative clinical effectiveness of rTMS treatment with and without iCBT as an innovative intervention for the treatment of participants diagnosed with TRD. <b>Methods:</b> This study is a prospective two-arm randomized controlled trial. Overall, 78 participants diagnosed with TRD were randomized to one of two treatment interventions: rTMS sessions alone and rTMS sessions plus iCBT. Participants in each group were made to complete evaluation measures at baseline, and 6 weeks (discharge) from treatment. The primary outcome measure was baseline to six weeks change in mean score for the 17-item Hamilton depression rating scale (HAMD-17). Secondary outcomes included mean baseline to six-week changes in the Columbia suicide severity rating scale (CSSRS) for the rate of suicidal ideations, the QIDS-SR16 for subjective depression, and the EQ-5D-5L to assess the quality of health in participants. <b>Results:</b> A majority of the participants were females 50 (64.1%), aged ≥ 40 39 (50.0%), and had college/university education 54 (73.0%). After adjusting for the baseline scores, the study failed to find a significant difference in the changes in mean scores for participants from baseline to six weeks between the two interventions under study on the HAMD-17 scale: F (1, 53) = 0.15, <i>p</i> = 0.70, partial eta squared = 0.003, CSSRS; F (1, 56) = 0.04 <i>p</i> = 0.85, partial eta squared = 0.001, QIDS-SR16 scale; F (1, 53) = 0.04 <i>p</i> = 0.61, partial eta squared = 0.005, and EQ-5D-VAS; F (1, 51) = 0.46 <i>p</i> = 0.50, and partial eta squared = 0.009. However, there was a significant reduction in means scores at week six compared to baseline scores for the combined study population on the HAMD-17 scale (42%), CSSRS (41%), QIDS-SR16 scale (35%), and EQ-VAS scale (62%). <b>Conclusion:</b> This study did not find that combined treatment of TRD with rTMS + iCBT (unguided) was superior to treatment with rTMS alone. Our findings do not support the use of combined treatment of rTMS + iCBT for the management of TRD disorders.https://www.mdpi.com/2076-3425/13/2/293repetitive transcranial magnetic stimulationtreatment-resistant depressioninternet-based cognitive behavioral therapyMoodGYMmajor depressive disorder |
| spellingShingle | Medard Kofi Adu Reham Shalaby Ejemai Eboreime Adegboyega Sapara Mobolaji A. Lawal Corina Chew Shelley Daubert Liana Urichuck Shireen Surood Daniel Li Mark Snaterse Mike Mach Pierre Chue Andrew J. Greenshaw Vincent I. O. Agyapong Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial Brain Sciences repetitive transcranial magnetic stimulation treatment-resistant depression internet-based cognitive behavioral therapy MoodGYM major depressive disorder |
| title | Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial |
| title_full | Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial |
| title_fullStr | Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial |
| title_full_unstemmed | Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial |
| title_short | Apparent Lack of Benefit of Combining Repetitive Transcranial Magnetic Stimulation with Internet-Delivered Cognitive Behavior Therapy for the Treatment of Resistant Depression: Patient-Centered Randomized Controlled Pilot Trial |
| title_sort | apparent lack of benefit of combining repetitive transcranial magnetic stimulation with internet delivered cognitive behavior therapy for the treatment of resistant depression patient centered randomized controlled pilot trial |
| topic | repetitive transcranial magnetic stimulation treatment-resistant depression internet-based cognitive behavioral therapy MoodGYM major depressive disorder |
| url | https://www.mdpi.com/2076-3425/13/2/293 |
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