A comparison of self- and observer-rated scales for detecting clinical improvement during repetitive transcranial stimulation (rTMS) treatment of depression

Michael K Leuchter; Cole Citrenbaum; Andrew C Wilson; Tristan D Tibbe; Nicholas J Jackson; David E Krantz; Scott A Wilke; Juliana Corlier; Thomas B Strouse; Gil D Hoftman; Reza Tadayonnejad; Ralph J Koek; Aaron R Slan; Nathaniel D Ginder; Margaret G Distler; Hewa Artin; John H Lee; Adesewa E Adelekun; Andrew F Leuchter

doi:10.1016/j.psychres.2023.115608

A comparison of self- and observer-rated scales for detecting clinical improvement during repetitive transcranial stimulation (rTMS) treatment of depression

Psychiatry Res. 2023 Dec:330:115608. doi: 10.1016/j.psychres.2023.115608. Epub 2023 Nov 14.

Authors

Michael K Leuchter¹, Cole Citrenbaum², Andrew C Wilson³, Tristan D Tibbe⁴, Nicholas J Jackson⁵, David E Krantz², Scott A Wilke², Juliana Corlier², Thomas B Strouse², Gil D Hoftman², Reza Tadayonnejad⁶, Ralph J Koek², Aaron R Slan², Nathaniel D Ginder², Margaret G Distler², Hewa Artin², John H Lee², Adesewa E Adelekun², Andrew F Leuchter²

Affiliations

¹ TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA. Electronic address: mkleuchter@mednet.ucla.edu.
² TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA.
³ Research Computing, University of Colorado Boulder, USA.
⁴ Department of Psychology, University of California, Los Angeles, CA 90024, USA; Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA.
⁵ Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA 90024, USA.
⁶ TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA 90024, USA; Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.

PMID: 37984281
DOI: 10.1016/j.psychres.2023.115608

Abstract

Clinical outcomes of repetitive Transcranial Magnetic Stimulation (rTMS) for treatment of Major Depressive Disorder (MDD) vary widely, and no single mood rating scale is standard for assessing rTMS outcomes. This study of 708 subjects undergoing clinical rTMS compared the performance of four scales in measuring symptom change during rTMS treatment. Self-report and observer ratings were examined weekly with the Inventory of Depressive Symptomatology 30-item (IDS), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item (POMS), and Hamilton Depression Rating Scale 17-item (HDRS). While all scales were correlated and detected significant improvement, the degree of improvement over time as well as response (33-50%) and remission (20-24%) rates varied significantly. Higher baseline severity was associated with lower likelihood of remission, and greater improvement by sessions 5 and 10 predicted response across all scales. Use of only a single scale to assess outcome conferred 14-36% risk of failing to detect response/remission indicated by another scale. The PHQ was most likely to indicate improvement and least likely to miss response or remission. These findings indicate that assessment of symptom burden during rTMS treatment may be most accurately assessed through use of multiple instruments.

Keywords: Early improvement; Major Depressive Disorder (MDD); Measurement-based care; Mood rating scales; Repetitive transcranial magnetic stimulation (rTMS).

MeSH terms

Depression
Depressive Disorder, Major* / diagnosis
Depressive Disorder, Major* / therapy
Humans
Prefrontal Cortex / physiology
Transcranial Magnetic Stimulation
Treatment Outcome