Low-frequency right repetitive transcranial magnetic stimulation for the treatment of depression after traumatic brain injury: A randomized sham-controlled pilot study

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Abstract

Objective: Major depression is the most common psychiatric sequela of traumatic brain injury (TBI), but effective treatment continues to be a challenge, with few studies providing guidance. Methods: In a pilot study, the authors evaluated the effect size of low-frequency right-sided (LFR) repetitive transcranial magnetic stimulation (rTMS), compared with sham treatment, over the right dorsolateral prefrontal cortex (DLPFC) in patients (N=30) with TBI depression and co-occurring neuropsychiatric symptoms, including suicidal thoughts, anxiety, posttraumatic stress disorder, sleep disturbance, behavioral problems, and cognitive dysfuncti on. Expl oratory anal yses of di ffusi on tensor imaging pre-and postintervention were performed to determine the effect size of LFR rTMS on white matter integrity. Results: Small (Hedge’s g=0.19) and highly variable effects of LRF rTMS over right DLPFC in TBI depression were observed. Similarly, the effect of LFR rTMS for treatment of comorbid neuropsychiatric symptoms varied from small to moderate. Conclusions: These findings suggest that the observed effects of LFR rTMS over the right DLPFC in TBI depression and co-occurring neuropsychiatric symptoms are small, at best, and, preliminarily, that low-frequency right DLPFC stimulation has limited potential in this patient population. However, studies employing different rTMS parameters (e.g., type, location, frequency, duration) or other participant characteristics (e.g., TBI severity, chronicity, comorbidity, concurrent treatment) may potentially yield different responses.

Original languageEnglish (US)
Pages (from-to)306-318
Number of pages13
JournalJournal of Neuropsychiatry and Clinical Neurosciences
Volume31
Issue number4
DOIs
StatePublished - Oct 2019

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Transcranial Magnetic Stimulation
Depression
Prefrontal Cortex
Therapeutics
Post-Traumatic Stress Disorders
Psychiatry
Traumatic Brain Injury
Comorbidity
Sleep
Anxiety
Placebos
Population

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

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title = "Low-frequency right repetitive transcranial magnetic stimulation for the treatment of depression after traumatic brain injury: A randomized sham-controlled pilot study",
abstract = "Objective: Major depression is the most common psychiatric sequela of traumatic brain injury (TBI), but effective treatment continues to be a challenge, with few studies providing guidance. Methods: In a pilot study, the authors evaluated the effect size of low-frequency right-sided (LFR) repetitive transcranial magnetic stimulation (rTMS), compared with sham treatment, over the right dorsolateral prefrontal cortex (DLPFC) in patients (N=30) with TBI depression and co-occurring neuropsychiatric symptoms, including suicidal thoughts, anxiety, posttraumatic stress disorder, sleep disturbance, behavioral problems, and cognitive dysfuncti on. Expl oratory anal yses of di ffusi on tensor imaging pre-and postintervention were performed to determine the effect size of LFR rTMS on white matter integrity. Results: Small (Hedge’s g=0.19) and highly variable effects of LRF rTMS over right DLPFC in TBI depression were observed. Similarly, the effect of LFR rTMS for treatment of comorbid neuropsychiatric symptoms varied from small to moderate. Conclusions: These findings suggest that the observed effects of LFR rTMS over the right DLPFC in TBI depression and co-occurring neuropsychiatric symptoms are small, at best, and, preliminarily, that low-frequency right DLPFC stimulation has limited potential in this patient population. However, studies employing different rTMS parameters (e.g., type, location, frequency, duration) or other participant characteristics (e.g., TBI severity, chronicity, comorbidity, concurrent treatment) may potentially yield different responses.",
author = "Vani Rao and Kathleen Bechtold and Una McCann and Durga Roy and Matthew Peters and Sandeep Vaishnavi and David Yousem and Susumu Mori and Haijuan Yan and Jeannie Leoutsakos and Michael Tibbs and Irving Reti",
year = "2019",
month = "10",
doi = "10.1176/appi.neuropsych.17110338",
language = "English (US)",
volume = "31",
pages = "306--318",
journal = "Journal of Neuropsychiatry and Clinical Neurosciences",
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TY - JOUR

T1 - Low-frequency right repetitive transcranial magnetic stimulation for the treatment of depression after traumatic brain injury

T2 - A randomized sham-controlled pilot study

AU - Rao, Vani

AU - Bechtold, Kathleen

AU - McCann, Una

AU - Roy, Durga

AU - Peters, Matthew

AU - Vaishnavi, Sandeep

AU - Yousem, David

AU - Mori, Susumu

AU - Yan, Haijuan

AU - Leoutsakos, Jeannie

AU - Tibbs, Michael

AU - Reti, Irving

PY - 2019/10

Y1 - 2019/10

N2 - Objective: Major depression is the most common psychiatric sequela of traumatic brain injury (TBI), but effective treatment continues to be a challenge, with few studies providing guidance. Methods: In a pilot study, the authors evaluated the effect size of low-frequency right-sided (LFR) repetitive transcranial magnetic stimulation (rTMS), compared with sham treatment, over the right dorsolateral prefrontal cortex (DLPFC) in patients (N=30) with TBI depression and co-occurring neuropsychiatric symptoms, including suicidal thoughts, anxiety, posttraumatic stress disorder, sleep disturbance, behavioral problems, and cognitive dysfuncti on. Expl oratory anal yses of di ffusi on tensor imaging pre-and postintervention were performed to determine the effect size of LFR rTMS on white matter integrity. Results: Small (Hedge’s g=0.19) and highly variable effects of LRF rTMS over right DLPFC in TBI depression were observed. Similarly, the effect of LFR rTMS for treatment of comorbid neuropsychiatric symptoms varied from small to moderate. Conclusions: These findings suggest that the observed effects of LFR rTMS over the right DLPFC in TBI depression and co-occurring neuropsychiatric symptoms are small, at best, and, preliminarily, that low-frequency right DLPFC stimulation has limited potential in this patient population. However, studies employing different rTMS parameters (e.g., type, location, frequency, duration) or other participant characteristics (e.g., TBI severity, chronicity, comorbidity, concurrent treatment) may potentially yield different responses.

AB - Objective: Major depression is the most common psychiatric sequela of traumatic brain injury (TBI), but effective treatment continues to be a challenge, with few studies providing guidance. Methods: In a pilot study, the authors evaluated the effect size of low-frequency right-sided (LFR) repetitive transcranial magnetic stimulation (rTMS), compared with sham treatment, over the right dorsolateral prefrontal cortex (DLPFC) in patients (N=30) with TBI depression and co-occurring neuropsychiatric symptoms, including suicidal thoughts, anxiety, posttraumatic stress disorder, sleep disturbance, behavioral problems, and cognitive dysfuncti on. Expl oratory anal yses of di ffusi on tensor imaging pre-and postintervention were performed to determine the effect size of LFR rTMS on white matter integrity. Results: Small (Hedge’s g=0.19) and highly variable effects of LRF rTMS over right DLPFC in TBI depression were observed. Similarly, the effect of LFR rTMS for treatment of comorbid neuropsychiatric symptoms varied from small to moderate. Conclusions: These findings suggest that the observed effects of LFR rTMS over the right DLPFC in TBI depression and co-occurring neuropsychiatric symptoms are small, at best, and, preliminarily, that low-frequency right DLPFC stimulation has limited potential in this patient population. However, studies employing different rTMS parameters (e.g., type, location, frequency, duration) or other participant characteristics (e.g., TBI severity, chronicity, comorbidity, concurrent treatment) may potentially yield different responses.

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