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

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.

[1]  M. Koeter,et al.  Health related quality of life in recurrent depression: a comparison with a general population sample. , 2010, Journal of affective disorders.

[2]  M. Thase,et al.  Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial. , 2008, The Journal of clinical psychiatry.

[3]  D. Schutter.  Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis , 2008, Psychological Medicine.

[4]  R. Kohn,et al.  Role of the family in recovery and major depression. , 1995, The American journal of psychiatry.

[5]  A. Stewart,et al.  The functioning and well-being of depressed patients. Results from the Medical Outcomes Study. , 1989, JAMA.

[6]  P. Mckeon,et al.  Long-term social functioning after depression treated by psychiatrists: a review. , 2007, Bipolar disorders.

[7]  R. Rosenthal,et al.  Selective publication of antidepressant trials and its influence on apparent efficacy. , 2008, The New England journal of medicine.

[8]  P. Bech.  Social Functioning , 2005, CNS drugs.

[9]  A. Rush,et al.  Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression. , 2006, The Journal of clinical psychiatry.

[10]  H. Sackeim,et al.  Poor health-related quality of life prior to ECT in depressed patients normalizes with sustained remission after ECT. , 2013, Journal of affective disorders.

[11]  M. Weissman,et al.  Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven Epidemiologic Catchment Area Study. , 1988, Journal of affective disorders.

[12]  H. Sackeim,et al.  The definition and meaning of treatment-resistant depression. , 2001, The Journal of clinical psychiatry.

[13]  C. Zlotnick,et al.  The relationship between quality of interpersonal relationships and major depressive disorder: findings from the National Comorbidity Survey. , 2000, Journal of affective disorders.

[14]  H. Rytsälä,et al.  Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder. , 2004, The Journal of clinical psychiatry.

[15]  K. Wells,et al.  Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population. , 1996, The American journal of psychiatry.

[16]  E. Paykel,et al.  DIMENSIONS OF SOCIAL ADJUSTMENT IN DEPRESSED WOMEN , 1971, The Journal of nervous and mental disease.

[17]  Sarah H Lisanby,et al.  Daily left prefrontal transcranial magnetic stimulation therapy for major depressive disorder: a sham-controlled randomized trial. , 2010, Archives of general psychiatry.

[18]  H. Fathy,et al.  Quality of Life: The Ultimate Outcome Measure of Interventions in Major Depressive Disorder , 2011, Harvard review of psychiatry.

[19]  M. Thase,et al.  Clinical significance of transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant depression: synthesis of recent data. , 2009, Psychopharmacology bulletin.

[20]  W H Rogers,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. , 1995, Medical care.

[21]  Sarah H. Lisanby,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 , 2010, Brain Stimulation.

[22]  H. Hoek,et al.  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. , 2010, The Journal of clinical psychiatry.

[23]  S. Hollon,et al.  Comparison of Quality of Life Measures in a Depressed Population , 2007, The Journal of nervous and mental disease.

[24]  Nicole K. Eberhart,et al.  Understanding the impact of prior depression on stress generation: examining the roles of current depressive symptoms and interpersonal behaviours. , 2008, British journal of psychology.

[25]  J. Endicott,et al.  Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. , 1993, Psychopharmacology bulletin.

[26]  David J. Kupfer,et al.  Size of Treatment Effects and Their Importance to Clinical Research and Practice , 2006, Biological Psychiatry.

[27]  John P. Rice,et al.  Psychosocial disability during the long-term course of unipolar major depressive disorder. , 2000, Archives of general psychiatry.

[28]  B. Reboussin,et al.  Effects of mood and age on quality of life in depressed inpatients. , 1999, Journal of affective disorders.

[29]  W. Coryell,et al.  Predicting recovery from episodes of major depression. , 2008, Journal of affective disorders.

[30]  A. Serretti,et al.  European Group for the Study of Resistant Depression (GSRD) — Where have we gone so far: Review of clinical and genetic findings , 2012, European Neuropsychopharmacology.

[31]  R. Post,et al.  Graphic representation of the life course of illness in patients with affective disorder. , 1988, The American journal of psychiatry.

[32]  M. Shear,et al.  Phenomenology and severity of major depression and comorbid lifetime anxiety disorders in primary medical care practice. , 1996, Anxiety.

[33]  C. Mulrow,et al.  Depressive disorders in primary care , 2007, Journal of General Internal Medicine.

[34]  Brian T Swanson,et al.  The Impact of Psychotherapy, Pharmacotherapy, and Their Combination on Quality of Life in Depression , 2011, Harvard review of psychiatry.

[35]  E. Arnold,et al.  Health-related quality of life and the practice of electroconvulsive therapy. , 2006, The journal of ECT.

[36]  T. Toikka,et al.  Health-related quality of life among patients with major depression , 2002, Nordic journal of psychiatry.

[37]  K. Walters,et al.  Chronic and Recurrent Depression in Primary Care: Socio-Demographic Features, Morbidity, and Costs , 2012, International journal of family medicine.

[38]  Michael F. Green,et al.  Training and quality assurance with the structured clinical interview for DSM-IV (SCID-I/P) , 1998, Psychiatry Research.

[39]  G. Klerman,et al.  Treatment effects on the social adjustment of depressed patients. , 1974, Archives of general psychiatry.

[40]  J. Greden.  The burden of disease for treatment-resistant depression. , 2001, The Journal of clinical psychiatry.

[41]  H. Sackeim,et al.  Health-related quality of life following ECT in a large community sample. , 2006, Journal of affective disorders.

[42]  William W. McDonald,et al.  Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial , 2007, Biological Psychiatry.

[43]  G. Klerman,et al.  Psycho-Social Predictors of Chronicity in Depressed Patients , 1986, British Journal of Psychiatry.

[44]  M. Valenstein,et al.  Early mortality and years of potential life lost among Veterans Affairs patients with depression. , 2012, Psychiatric services.

[45]  L. Judd.  Major depressive disorder: longitudinal symptomatic structure, relapse and recovery , 2001, Acta psychiatrica Scandinavica.

[46]  A. Beekman,et al.  Duration and severity of depression predict mortality in older adults in the community , 2002, Psychological Medicine.

[47]  W. Coryell,et al.  Psychosocial impairment and recurrence of major depression. , 2004, Comprehensive psychiatry.