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Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in US Veterans

Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in... Key PointsQuestionIs repetitive transcranial magnetic stimulation an efficacious treatment for treatment-resistant major depression in patients who are veterans? FindingsIn this randomized clinical trial of 164 US veterans with depression, the overall remission rate was 39%, with no significant difference between the active and sham groups. Patients with comorbid posttraumatic stress disorder showed the least improvement. MeaningThese findings may reflect the importance of close clinical surveillance, rigorous monitoring of concomitant medication, and regular interaction with clinic staff in bringing about significant improvement in this treatment-resistant population. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Psychiatry American Medical Association

Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in US Veterans

Research JAMA Psychiatry | Original Investigation Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in US Veterans A Randomized Clinical Trial Jerome A. Yesavage, MD; J. Kaci Fairchild, PhD; Zhibao Mi, PhD; Kousick Biswas, PhD; Anne Davis-Karim, PharmD; Ciaran S. Phibbs, PhD; Steven D. Forman, MD, PhD; Michael Thase, MD; Leanne M. Williams, PhD; Amit Etkin, MD, PhD; Ruth O’Hara, PhD; Gerald Georgette, RN; Tamara Beale, MA; Grant D. Huang, MPH, PhD; Art Noda, MS; Mark S. George, MD; for the VA Cooperative Studies Program Study Team Editorial page 877 IMPORTANCE Treatment-resistant major depression (TRMD) in veterans is a major clinical Supplemental content challenge given the high risk for suicidality in these patients. Repetitive transcranial magnetic stimulation (rTMS) offers the potential for a novel treatment modality for these veterans. OBJECTIVE To determine the efficacy of rTMS in the treatment of TRMD in veterans. DESIGN, SETTING, AND PARTICIPANTS A double-blind, sham-controlled randomized clinical trial was conducted from September 1, 2012, to December 31, 2016, in 9 Veterans Affairs medical centers. A total of 164 veterans with TRD participated. INTERVENTIONS Participants were randomized to either left prefrontal rTMS treatment (10 Hz, 120% motor threshold, 4000 pulses/session) or to sham (control) rTMS treatment for up to 30 treatment sessions. MAIN OUTCOMES AND MEASURES The primary dependent measure of the intention-to-treat analysis was remission rate (Hamilton Rating Scale for Depression score10, indicating that depression is in remission and not a clinically significant burden), and secondary analyses were conducted on other indices of posttraumatic stress disorder, depression, hopelessness, suicidality, and quality of life. RESULTS The 164 participants had a mean (SD) age of 55.2 (12.4) years, 132 (80.5%) were men, and 126 (76.8%) were of white race. Of these, 81 were randomized to receive active...
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Publisher
American Medical Association
Copyright
Copyright 2018 American Medical Association. All Rights Reserved.
ISSN
2168-622X
eISSN
2168-6238
DOI
10.1001/jamapsychiatry.2018.1483
Publisher site
See Article on Publisher Site

Abstract

Key PointsQuestionIs repetitive transcranial magnetic stimulation an efficacious treatment for treatment-resistant major depression in patients who are veterans? FindingsIn this randomized clinical trial of 164 US veterans with depression, the overall remission rate was 39%, with no significant difference between the active and sham groups. Patients with comorbid posttraumatic stress disorder showed the least improvement. MeaningThese findings may reflect the importance of close clinical surveillance, rigorous monitoring of concomitant medication, and regular interaction with clinic staff in bringing about significant improvement in this treatment-resistant population.

Journal

JAMA PsychiatryAmerican Medical Association

Published: Sep 27, 2018

References

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