Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa: A series of nine cases
Introduction: This case series documents local experience using accelerated theta-burst repetitive transcranial magnetic stimulation (rTMS) as a supplementary treatment for depression in both major depressive disorder (MDD) and bipolar disorder (BD). Methods: Nine consenting patients (MDD = 7; BD [...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
AOSIS
2018-10-01
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| Series: | South African Journal of Psychiatry |
| Online Access: | https://sajp.org.za/index.php/sajp/article/view/1272 |
| _version_ | 1818547627952701440 |
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| author | Erine Bröcker Leigh van den Heuvel Soraya Seedat |
| author_facet | Erine Bröcker Leigh van den Heuvel Soraya Seedat |
| author_sort | Erine Bröcker |
| collection | DOAJ |
| description | Introduction: This case series documents local experience using accelerated theta-burst repetitive transcranial magnetic stimulation (rTMS) as a supplementary treatment for depression in both major depressive disorder (MDD) and bipolar disorder (BD).
Methods: Nine consenting patients (MDD = 7; BD [major depressive episode] = 2) received the accelerated theta-burst protocol consisting of three magnetic pulses delivered 20 ms apart and repeatedly delivered every 200 ms, resulting in a 5 Hz theta rhythm over the left dorsolateral prefrontal cortex (DLPFC). Treatment comprised 20 sessions delivered over 8 days. Accelerated theta burst rTMS treatment provides more stimuli over a shorter period of time, thus potentially increasing feasibility and cost-effectiveness. Improvement was monitored using the Centre for Epidemiological Studies Depression (CES-D) scale and the Clinical Global Impression (CGI) scale at baseline, day 5 and day 8 of rTMS treatment. All patients remained on their prescribed medication for the duration of rTMS treatment. We performed a Wilcoxon matched-pairs signed rank test to determine whether there was a difference in scores from baseline to post-treatment. The CES-D scores decreased significantly from baseline (Mdn 38.0; IQR 31.0; 51.0) to post-treatment (Mdn 17.0; IQR 11.0; 28.5; Z = -2.55, p = 0.011). The CGI severity scores also decreased significantly between baseline (Mdn 4.0; IQR 4.0; 5.0) and post-treatment (Mdn 3.0; IQR 3.0; 4.0; Z = -2.43, p = 0.015).
Results: Five patients demonstrated at least a 50% symptom reduction on the CES-D scale. The most commonly reported adverse effect was mild headache, which lasted a few hours during and post-rTMS treatment.
Conclusion: A limitation of these findings is that this was a small case series without a control arm; however, the findings suggest that the accelerated theta burst rTMS protocol for depression was well tolerated with most patients also experiencing symptomatic improvement by day 8. |
| first_indexed | 2024-12-12T08:09:16Z |
| format | Article |
| id | doaj.art-918f477f390543e69238e690a6cb9950 |
| institution | Directory Open Access Journal |
| issn | 1608-9685 2078-6786 |
| language | English |
| last_indexed | 2024-12-12T08:09:16Z |
| publishDate | 2018-10-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Journal of Psychiatry |
| spelling | doaj.art-918f477f390543e69238e690a6cb99502022-12-22T00:31:50ZengAOSISSouth African Journal of Psychiatry1608-96852078-67862018-10-0124010.4102/sajpsychiatry.v24i0.1272433Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa: A series of nine casesErine Bröcker0Leigh van den Heuvel1Soraya Seedat2Faculty of Health Sciences, Stellenbosch UniversityFaculty of Health Sciences, Stellenbosch UniversityFaculty of Health Sciences, Stellenbosch UniversityIntroduction: This case series documents local experience using accelerated theta-burst repetitive transcranial magnetic stimulation (rTMS) as a supplementary treatment for depression in both major depressive disorder (MDD) and bipolar disorder (BD). Methods: Nine consenting patients (MDD = 7; BD [major depressive episode] = 2) received the accelerated theta-burst protocol consisting of three magnetic pulses delivered 20 ms apart and repeatedly delivered every 200 ms, resulting in a 5 Hz theta rhythm over the left dorsolateral prefrontal cortex (DLPFC). Treatment comprised 20 sessions delivered over 8 days. Accelerated theta burst rTMS treatment provides more stimuli over a shorter period of time, thus potentially increasing feasibility and cost-effectiveness. Improvement was monitored using the Centre for Epidemiological Studies Depression (CES-D) scale and the Clinical Global Impression (CGI) scale at baseline, day 5 and day 8 of rTMS treatment. All patients remained on their prescribed medication for the duration of rTMS treatment. We performed a Wilcoxon matched-pairs signed rank test to determine whether there was a difference in scores from baseline to post-treatment. The CES-D scores decreased significantly from baseline (Mdn 38.0; IQR 31.0; 51.0) to post-treatment (Mdn 17.0; IQR 11.0; 28.5; Z = -2.55, p = 0.011). The CGI severity scores also decreased significantly between baseline (Mdn 4.0; IQR 4.0; 5.0) and post-treatment (Mdn 3.0; IQR 3.0; 4.0; Z = -2.43, p = 0.015). Results: Five patients demonstrated at least a 50% symptom reduction on the CES-D scale. The most commonly reported adverse effect was mild headache, which lasted a few hours during and post-rTMS treatment. Conclusion: A limitation of these findings is that this was a small case series without a control arm; however, the findings suggest that the accelerated theta burst rTMS protocol for depression was well tolerated with most patients also experiencing symptomatic improvement by day 8.https://sajp.org.za/index.php/sajp/article/view/1272 |
| spellingShingle | Erine Bröcker Leigh van den Heuvel Soraya Seedat Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa: A series of nine cases South African Journal of Psychiatry |
| title | Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa: A series of nine cases |
| title_full | Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa: A series of nine cases |
| title_fullStr | Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa: A series of nine cases |
| title_full_unstemmed | Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa: A series of nine cases |
| title_short | Accelerated theta-burst repetitive transcranial magnetic stimulation for depression in South Africa: A series of nine cases |
| title_sort | accelerated theta burst repetitive transcranial magnetic stimulation for depression in south africa a series of nine cases |
| url | https://sajp.org.za/index.php/sajp/article/view/1272 |
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