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Cited by 70Transcranial Magnetic Stimulation StudiesTreatment of Major DepressionElectroconvulsive Therapy Studies

Unilateral and bilateral repetitive transcranial magnetic stimulation for treatment-resistant late-life depression

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Trevizol, Alisson Paulino, Goldberger, Kyle W., Mulsant, Benoit H., Rajji, Tarek K., Downar, Jonathan, Daskalakis, Zafiris J., Blumberger, Daniel M.·2019·International Journal of Geriatric Psychiatry
DOI 10.1002/gps.5091PMC PMC6488425
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Abstract

Background: The management of late‐life depression is challenged by high rates of treatment‐resistance and adverse effects, along with medical comorbidities and polypharmacy. Together with the limited data on managing treatment‐resistant depression in older adults, there is a need for investigating the efficacy of nonpharmacological treatment strategies. Repetitive transcranial magnetic stimulation (rTMS) is one modality that may better serve this patient population. Methods: The present study examines data from two previous clinical trials (NCT00305045 and NCT01515215) to explore the efficacy of bilateral and unilateral high‐frequency left‐sided (HFL) rTMS in older adults suffering from treatment‐resistant depression. A total of 43 adults aged 60 or older with a current major depressive episode were randomized to bilateral sequential, unilateral HFL, or sham. Bilateral sequential stimulation involved low‐frequency (1 Hz) right dorsolateral prefrontal cortex (DLPFC) stimulation followed immediately by high‐frequency (10 Hz) left DLPFC. The unilateral condition was HFL stimulation alone, and the placebo condition was either HFL or sequential bilateral form of sham. The primary outcome was remission of depression. Results: Participants receiving bilateral rTMS experienced greater remission rates (40%) compared with unilateral (0%) or sham (0%) groups. Response to rTMS in the Hamilton Depression Rating Scale scores similarly favored the efficacy of bilateral rTMS. Conclusion: This study suggests that sequential bilateral treatment may be an optimal form of rTMS when used for treatment‐resistant depression in older adults. Further large‐scale comparative effectiveness trials of bilateral rTMS in this population are warranted.

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  • The remission rate of 35.4% in the bilateral TBS group is comparable to those in the authors' previous bilateral rTMS trial (33%) and deep rTMS trial (40%) and to aripiprazole augmentation in older adults with treatment-resistant depression.

    “This remission rate is comparable with those seen in our previous bilateral rTMS trial (33%)7 and deep rTMS trial (40%)32 and comparable with the remission rate seen with aripiprazole augmentation in older adults with TRD.33”

    From Effectiveness of Standard Sequential Bilateral Repetitive Transcranial Magnetic Stimulation vs Bilateral Theta Burst Stimulation in Older Adults With Depression (2022) · cites this paper as [7]

    Citation 7 is attached to the previous bilateral rTMS trial’s reported 33% remission rate. The cited paper’s Results section (page unavailable) instead reports remission in 8 of 20 bilateral rTMS participants, or 40%. The deep rTMS and aripiprazole comparisons have separate citations. (LLM, conf=0.90)

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  • In 2 separate studies, our group found superior remission rates with bilateral stimulation (40%) compared with both left-unilateral (0%) and sham (0%) stimulation in older patients with treatment-resistant depression.

    “our group found in 2 separate studies superior remission rates with bilateral stimulation (40%) compared with both left-unilateral (0%) and sham (0%) stimulation in older patients with TRD.7”

    From Effectiveness of Standard Sequential Bilateral Repetitive Transcranial Magnetic Stimulation vs Bilateral Theta Burst Stimulation in Older Adults With Depression (2022) · cites this paper as [7]

    The Results (page unavailable) report remission rates of 40% with bilateral rTMS and 0% with both left-unilateral and sham rTMS in older adults with treatment-resistant depression. The Methods and Results describe a combined analysis of participants from two previous trials, not separate demonstrations of those rates in each study. (LLM, conf=0.85)

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  • The present study used bilateral stimulation rather than unilateral stimulation based on data suggesting better response to bilateral stimulation compared with sham in older adults and data demonstrating efficacy of bilateral cTBS/iTBS compared with sham in adults.

    “The present study used bilateral stimulation, rather than the unilateral stimulation in the THREE-D trial, based on data suggesting better response to bilateral stimulation compared with sham in older adults7 and data demonstrating efficacy of bilateral cTBS/iTBS compared with sham in adults.12,36”

    From Effectiveness of Standard Sequential Bilateral Repetitive Transcranial Magnetic Stimulation vs Bilateral Theta Burst Stimulation in Older Adults With Depression (2022) · cites this paper as [7]

  • A sample size of 200 participants was estimated to be required to determine if bilateral TBS was noninferior to bilateral rTMS with 80% power and a 1-sided alpha of 0.05, using a δ of 2.75 and a standard deviation of change of 7.8.

    “we used a δ of 2.75 and a standard deviation of change of 7.8 and estimated a sample size of 200 participants was required to determine if bilateral TBS was noninferior to bilateral rTMS with 80% power and a 1-sided alpha of 0.05.”

    From Effectiveness of Standard Sequential Bilateral Repetitive Transcranial Magnetic Stimulation vs Bilateral Theta Burst Stimulation in Older Adults With Depression (2022) · cites this paper as [7]

    The Results section reports an analysis of 43 participants assigned to bilateral rTMS, unilateral rTMS, or sham; it does not report a bilateral TBS comparison. Searches for the 200-participant noninferiority calculation and the values 2.75 and 7.8 found no passage addressing that calculation. Page numbers were unavailable in our copy. (LLM, conf=0.78)

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Authors
Trevizol, A. P., Goldberger, K. W., Mulsant, B. H., Rajji, T. K., Downar, J., Daskalakis, Z. J., & Blumberger, D. M.
Affiliations
  • Centre for Addiction and Mental Health (CA)
  • McMaster University (CA)
  • University of Toronto (CA)
  • University Health Network (CA)
Corresponding author
Blumberger, Daniel M.
ORCID
Venue
International Journal of Geriatric Psychiatry
Publisher
Wiley
Published
2019-04-08
Volume
34
Issue
6
Pages
822-827
ISSN
  • 0885-6230 (ISSN-L)
  • 1099-1166
DOI
10.1002/gps.5091
PMC
PMC6488425
OpenAlex
W2921305216
Cited by
70
References
38
Citations by year
2026: 10 · 2025: 17 · 2024: 10 · 2023: 9 · 2022: 9 · 2021: 9 · 2020: 3 · 2019: 3
FWCI
2.64
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • International Journal of Geriatric Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Canadian Institutes of Health Research
  • Ontario Mental Health Foundation
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
repetitive transcranial magnetic stimulation, treatment-resistant depression, geriatric depression, older adults, high-frequency stimulation, dorsolateral prefrontal cortex, depression remission, non-pharmacological treatment
MeSH terms
Aged, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Transcranial Magnetic Stimulation, Depressive Disorder, Treatment-Resistant

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