Predictors of remission after repetitive transcranial magnetic stimulation for the treatment of late-life depression

Katharina Göke; Alisson P Trevizol; Clement Ma; Linda Mah; Tarek K Rajji; Zafiris J Daskalakis; Jonathan Downar; Shawn M McClintock; Sean M Nestor; Yoshihiro Noda; Benoit H Mulsant; Daniel M Blumberger

doi:10.1016/j.psychres.2024.115822

Predictors of remission after repetitive transcranial magnetic stimulation for the treatment of late-life depression

Psychiatry Res. 2024 Apr:334:115822. doi: 10.1016/j.psychres.2024.115822. Epub 2024 Feb 29.

Authors

Affiliations

¹ Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada.
² Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
³ Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁴ Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
⁵ Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
⁶ Department of Psychiatry, University of California, San Diego Health, California, USA.
⁷ Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁹ Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
¹⁰ Department of Neuropsychiatry, Faculty of Medicine, Keio University School of Medicine, Tokyo, Japan.
¹¹ Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹² Temerty Centre for Therapeutic Brain Intervention and Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: daniel.blumberger@camh.ca.

PMID: 38452496
DOI: 10.1016/j.psychres.2024.115822

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment in patients with depression, yet treatment response remains variable. While previous work has identified predictors of remission in younger adults, relatively little data exists in late-life depression (LLD). To address this gap, data from 164 participants with LLD from a randomized non-inferiority treatment trial comparing standard bilateral rTMS to bilateral theta burst stimulation (TBS) (ClinicalTrials.gov identifier: NCT02998580) were analyzed using binary logistic regression and conditional inference tree (CIT) modeling. Lower baseline depression symptom severity, fewer prior antidepressant treatment failures, and higher global cognition predicted remission following rTMS treatment. The CIT predicted a higher likelihood of achieving remission for patients with a total score of 19 or lower on the Montgomery-Åsberg Depression Rating Scale, 1 or fewer prior antidepressant treatment failures, and a total score of 23 or higher on the Montreal Cognitive Assessment. Our results indicate that older adults with lower severity of depression, fewer antidepressant treatment failures, and higher global cognition benefit more from current forms of rTMS. The results suggest that there is potentially higher value in using rTMS earlier in the treatment pathway for depression in older adults.

Keywords: Brain stimulation; Late-life depression; Repetitive transcranial magnetic stimulation; Treatment-resistant depression.

MeSH terms

Aged
Antidepressive Agents / therapeutic use
Depression / therapy
Depressive Disorder, Major* / psychology
Equivalence Trials as Topic
Humans
Prefrontal Cortex / physiology
Randomized Controlled Trials as Topic
Transcranial Magnetic Stimulation* / methods
Treatment Outcome

Substances

Antidepressive Agents

Associated data

ClinicalTrials.gov/NCT02998580