A new study suggests that transcranial magnetic stimulation (TMS) is associated with both anxiolytic and antidepressant effects in people with anxiety depression.
An analysis of data from over 1800 patients diagnosed with Major Depressive Disorder (MDD) found that over 75% had anxiety. After TMS, patients with anxiety depression had at least a 50% reduction in anxiety and depression scores from baseline.
Furthermore, the anxious and non-anxious groups showed comparable absolute improvements in scores measuring depression.
“The ultimate message is that TMS is highly effective in the more difficult-to-treat and handicapped population of anxiety-depressive patients,” said co-investigator Scott Aaronson, MD, chief scientific officer, advanced diagnostics. The Director of the Institute of Therapeutics said: said Shepard Pratt of the Psychedelic Center of Excellence, Towson, Maryland. Medscape medical news.
The survey results were published online on January 11, 2023.
large cohort
Dr. Aaronson, who is also an adjunct professor at the University of Maryland School of Medicine in Baltimore, noted that between 50% and 75% of people with depression have severe anxiety symptoms.
“The presence of significant anxiety in people with depression significantly increases the severity, impairment, chronicity, and suicidality of depressive symptoms,” he said.
In general, “when anxiety-depressed patients are identified in treatment studies, they are less likely to respond to index treatments and are often excluded from some treatment trials,” he added.
Aaronson noted that previously reported results of TMS for anxiety depression “suggest efficacy but have not been well studied within large cohorts.”
To investigate these issues, current investigators turned to the NeuroStar Advanced Therapy System Clinical Outcomes Registry. This is the largest database of patients with refractory depression who all underwent her TMS.
This ‘extraordinary’ database reveals how often TMS works, whether some of the treatment parameters can be altered while maintaining efficacy, and whether bilateral TMS works better than unilateral TMS in patients with MDD. Aaronson said he was able to provide earlier insight as to whether.
In the current study, researchers retrospectively analyzed data from 1820 MDD patients. All completed the Patient Health Questionnaire-9 (PHQ-9) and Global Anxiety Disorder-7 (GAD-7) at baseline and he had at least one of her TMS interventions.
Most patients (n = 1514) had anxiety depression, defined as a baseline GAD-7 score of 10 or greater, and 306, defined as having a GAD-7 score below that threshold. It was a non-anxiety depression.
The researchers evaluated a full sample of these patients treated with the TMS protocol and a subsample of patients (n = 625) treated with only high-frequency left dorsolateral prefrontal cortex (HF-LUL) stimulation. bottom.
Patients were also subdivided into intent-to-treat and completer samples (n = 1820 and 1429, respectively).
consistent effect
There was no difference in gender distribution between the anxious and non-anxious groups.
However, the anxious group was significantly younger (approximately 5 years) than the anxious group. They also reported greater severity of depressive symptoms at baseline, with PHQ-9 scores approximately 2.5 points higher.
This “was a remarkable finding because the PHQ-9 does not include a direct assessment of anxiety,” the researchers wrote.
There were also differences between groups in the type of TMS protocol received, with exclusive HF-LUL being more favorable in the non-anxiety-depression group compared with other types of TMS protocols or unclassified protocols in the anxiety-depression group. was more common.
“Anxiolytic and antidepressant effects were consistent across the ITT and Completed samples and patients who received the TMS protocol or HF-LUL TMS alone,” the researchers reported.
GAD-7 scores were ‘significantly decreased’ in the anxiety-depression group. GAD-7 response rates ranged from 47.8% to 60.6% and GAD-7 remission rates ranged from 26.4% to 38.0% (both P.s < .0001).
There was no between-group difference in PHQ-9 scores in terms of magnitude of change before and after treatment. The anxious group was approximately 2.5 points higher both before and after treatment compared to the anxious group. It was in the range of 1.95.
Response, remission rate
Notably, both the anxious and non-anxious groups showed a ‘significant antidepressant effect’, with response and remission rates in the anxious group ranging from 55.2% to 66.8% and 24.0% to 33.2%, respectively.
However, response and remission rates were significantly higher in the non-anxious and anxious groups.
“Thus, higher baseline and post-TMS scores in the anxiety group significantly reduced response and remission rates, despite similar changes in PHQ-9 scores,” the researchers said. is writing
They noted that the differences in TMS-adjusted means were “small” and that “there were no differences in the absolute extent of multivariate-adjusted symptom improvement.”
The relationship between GAD-7 and PHQ-9 scores changes ‘covariate’ across IT samples (r1818 = .69, P. < .001), although the relationship between the anxiety-depression and non-anxiety-depression groups was more 'robust' (r1512 = .75 vs. r304 = .50; both P.s < .001).
“People who were anxious and depressed were more ill and had higher scores on scales that capture disease severity,” Aaronson said. The results were similar when we took into account the higher baseline scores, which had the effect of lowering the proportion of anxious participants.”
He reported that mean declines in Depression Rating Scale scores were not significantly different between groups, and that declines in depression scores tracked similarly to declines in anxiety scores, “meaning they strongly covaried.” .
The authors noted the limitation that although the data were collected prospectively, the analysis was retrospective.
Settle the debate?
Comments on Medscape Medical NewsClinicians know that patients with comorbid anxiety are less likely to be referred to TMS, said Shan Siddiqi, M.D., Ph.D., assistant professor of psychiatry at Harvard Medical School in Boston, Massachusetts. Good for them. ”
This perception persists “despite some small studies to the contrary, perhaps because we know that these patients respond poorly to other treatments.” Boston, Massachusetts. He was not involved in the current research.
“We hope that this new study will settle that debate and move on to a new question: how to optimize treatment for this important patient population that has been largely excluded from many previous studies. That’s it.”
NeuroStar Advanced Therapy System Clinical Outcomes Registry, analysis of registry data, and drafting of this manuscript were supported by Neuronetics Inc. Aaronson He serves as scientific advisor to Genomind Inc., LivaNova PLC, Neuronetics Inc., Janssen Pharmaceuticals Inc., and Sage Therapeutics, and receives research support from Compass Pathways Inc. and Neuronetics Inc. paper. Siddiqi is a scientific consultant at Magnus Medical. Clinical consultant for Acacia Mental Health, Kaizen Brain Center and Boston Precision Neurotherapeutics. He has received investigator-led research funding from Neuronetics and BrainsWay. He has also been a speaker on BrainsWay and He PsychU.org, owns shares in BrainsWay and Magnus Medical, and owns intellectual property on the use of functional connectivity to target TMS.
J Clin Psychiatry. Published online on January 11, 2023. Full article.
Batya Swift Yasgur, Massachusetts, LSW is a freelance writer in counseling in Teaneck, NJ. She is a regular contributor to numerous medical publications, including Medscape and her WebMD, as well as consumer health books and Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom. Memoirs of a Brave Afghan Sister Who Told Her).
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