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

Predictors of remission after repetitive transcranial magnetic stimulation for the treatment of major depressive disorder: an analysis from the randomised non-inferiority THREE-D trial

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Trevizol, Alisson P., Downar, Jonathan, Vila-Rodriguez, Fidel, Thorpe, Kevin E., Daskalakis, Zafiris J., Blumberger, Daniel M.·2020·EClinicalMedicine
DOI 10.1016/j.eclinm.2020.100349PMC PMC7200243
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Abstract

BACKGROUND: Although repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for major depressive disorder (MDD), treatment selection is still mainly a process of trial-and-error. The present study aimed to identify clinical predictors of remission after a course of rTMS delivered to the left DLPFC to improve patient selection. METHODS: Data from a large randomised non-inferiority trial comparing standard 10 Hz and intermittent theta burst stimulation (iTBS) for the treatment of MDD were used for the exploratory analyses. Individual variables were assessed for their association with remission and then included in a logistic regression model to determine odds ratios (OR) and corresponding 95% confidence intervals. Model discrimination (internal validation) was carried out to assess model optimism using the c-index. ClinicalTrials.gov identifier: NCT01887782. FINDINGS: 388 subjects were included in the analysis (199-iTBS and 189-10 Hz, respectively). Higher baseline severity of both depressive and anxiety symptoms were associated with a lower chance of achieving remission (OR=0.64, 95% CI 0.46-0.88; and 0.78, 95% CI 0·60-0.98, respectively). Current employment was a positive predictor for remission (OR=1.69, 95% CI 1.06-2.7), while greater number of treatment failures was associated with lower odds of achieving remission (OR=0.51, 95% CI 0.27-0.98). A non-linear effect of age and remission was observed. An analysis to allow an estimate of the probability of remission using all variables was assessed. The c-index for the fitted model was 0.687. INTERPRETATION: Our results suggest that measuring depression symptom severity, employment status, and refractoriness are important in prognosticating outcome to a course of rTMS in MDD. FUNDING: Canadian Institutes of Health Research MOP-136801.

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  • The results of both the THREE-D study and the present FOUR-D study indicate that rTMS outcomes in older adults can be at least as good, and perhaps better, as in younger adults.

    “Although there is a pervasive assumption that rTMS in general is not well suited for older adults with TRD, the results of both the THREE-D study43 and the present FOUR-D study indicate that rTMS outcomes in older adults can be at least as good, and perhaps better, as in younger adults.”

    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 [43]

    The Results report a modest age-related pattern in remission odds, and the Discussion says that poorer rTMS outcomes with increasing age were not observed in this analysis. However, Methods > Participants limits the sample to ages 18–65, and the Discussion explicitly says the results cannot be generalized to people over 65. THREE-D therefore offers some support for the comparison within its age range, but not for older adults generally. (LLM, conf=0.86)

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Cited by

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Authors
Trevizol, A. P., Downar, J., Vila-Rodriguez, F., Thorpe, K. E., Daskalakis, Z. J., & Blumberger, D. M.
Affiliations
  • Centre for Addiction and Mental Health (CA)
  • University Health Network (CA)
  • University of Toronto (CA)
Corresponding author
Blumberger, Daniel M.
ORCID
Venue
EClinicalMedicine
Publisher
Elsevier BV
Published
2020-05
Volume
22
Pages
100349
ISSN
2589-5370 (ISSN-L)
DOI
10.1016/j.eclinm.2020.100349
PMC
PMC7200243
OpenAlex
W3022337098
Cited by
70
References
7
Citations by year
2026: 8 · 2025: 11 · 2024: 13 · 2023: 15 · 2022: 12 · 2021: 7 · 2020: 3 · 2019: 1
FWCI
3.58
Type
journal article
Language
en
Open access
Licence
Locations
  • EClinicalMedicine (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Canadian Institutes of Health Research
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, major depressive disorder, remission prediction, left dorsolateral prefrontal cortex, intermittent theta burst stimulation, baseline symptom severity, anxiety symptoms, employment status, treatment refractoriness, prognostic factors

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