Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) Add-On Therapy to a Standard Treatment in Individuals with Multiple Sclerosis and Concomitant Symptoms of Depression-Results from a Randomized Clinical Trial and Pilot Study

Mohammad Ahmadpanah; Shiva Amini; Mehrdokht Mazdeh; Mohammad Haghighi; Alireza Soltanian; Leila Jahangard; Amir Keshavarzi; Serge Brand

doi:10.3390/jcm12072525

Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) Add-On Therapy to a Standard Treatment in Individuals with Multiple Sclerosis and Concomitant Symptoms of Depression-Results from a Randomized Clinical Trial and Pilot Study

J Clin Med. 2023 Mar 27;12(7):2525. doi: 10.3390/jcm12072525.

Authors

Mohammad Ahmadpanah^{1

2}, Shiva Amini², Mehrdokht Mazdeh³, Mohammad Haghighi², Alireza Soltanian⁴, Leila Jahangard², Amir Keshavarzi², Serge Brand^{5

6

7

8

9

10}

Affiliations

¹ Department of Clinical Psychology, School of Medicine, Hamadan University of Medical Sciences, Hamadan 6517838636, Iran.
² Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan 6517838636, Iran.
³ Department of Neurology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan 6517838636, Iran.
⁴ Department of Biostatistics, School of Public Health, Modeling of Non-Communicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan 6517838636, Iran.
⁵ Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, 4002 Basel, Switzerland.
⁶ Division of Sport and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, 4052 Basel, Switzerland.
⁷ Sleep Disorders Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6714869914, Iran.
⁸ Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6714869914, Iran.
⁹ School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 1419733141, Iran.
¹⁰ Center for Disaster Psychiatry and Disaster Psychology, Psychiatric Clinics of the University of Basel, 4002 Basel, Switzerland.

Abstract

Background: Compared to the general population, persons with multiple sclerosis (MS) are at increased risk of suffering from major depressive disorder (MDD). Repetitive Transcranial Magnetic Stimulation (rTMS) was used successfully to treat individuals with MDD. Here, we conducted a randomized clinical trial and pilot study, and tested the effectiveness of rTMS adjuvant to a standard pharmacological treatment among persons with MS, compared to a sham condition.

Materials and methods: A total of 40 persons with MS (mean age: 32 years; 42.5% females; median EDSS score: 4) and with moderate to severe symptoms of depression were randomly assigned to the rTMS or to the rTMS sham condition, always as adjuvant intervention to the standard treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI). rTMS consisted of 10 sessions each of 37.5 min; the sham condition was identical to the active condition except for the absence of rTMS stimuli. At the beginning and two weeks after the end of the study, participants reported on their fatigue, while experts rated the severity of participants' depressive symptoms (Montgomery-Asberg Depression Rating Scale; MADRS), cognitive performance (Montreal Cognitive Assessment; MoCA), and degree of disability (Expanded Disability Status Scale; EDSS).

Results: Data were analyzed per intent-to-treat. Scores for depression, fatigue, and EDSS declined significantly over time (large effect sizes), but more so in the rTMS condition than in the sham condition (large effect sizes for the time by group-interactions). Compared to the sham condition, scores for depression were significantly lower in the rTMS condition. Scores for cognition improved over time in both study conditions (large effect size).

Conclusion: Compared to a sham condition, adjuvant rTMS to a standard pharmacological treatment ameliorated typical MS-related symptoms (depression; fatigue; EDSS scores). Results from this pilot study suggested that rTMS might be routinely applied in persons with MS displaying symptoms of depression and fatigue.

Keywords: EDSS; depression; fatigue; multiple sclerosis; rTMS; sham condition.

Grants and funding

The entire study was financially supported by internal fundings of the Vice chancellor of Research and Technology of the Hamadan University of Medical Sciences (HUMS; Hamadan, Iran). Research Grant: 140007065699.