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The priming effect of repetitive transcranial magnetic stimulation on clinical response to electroconvulsive therapy in treatment-resistant depression: a randomized, double-blind, sham-controlled study

Published online by Cambridge University Press:  28 September 2021

Maud Rothärmel ,
Pierre Quesada ,
Thomas Husson ,
Ghina Harika-Germaneau ,
Clément Nathou ,
Julien Guehl ,
Marine Dalmont ,
Gaëlle Opolczynski ,
Iris Miréa-Grivel  and
Bruno Millet
...Show all authors
Maud Rothärmel*
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
Pierre Quesada
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
Thomas Husson
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France Rouen University Hospital, Rouen, France INSERM U 1245 University of Rouen, Rouen, France
Ghina Harika-Germaneau
Affiliation:
Centre Hospitalier Henri Laborit, Poitiers, France
Clément Nathou
Affiliation:
UNICAEN, ISTS, EA 7466, GIP Cyceron, Caen 14000, France CHU de Caen, Service de Psychiatrie adulte, Caen 14000, France UFR Santé UNICAEN, 2 rue des Rochambelles, Caen 14000, France
Julien Guehl
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
Marine Dalmont
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France Rouen University Hospital, Rouen, France
Gaëlle Opolczynski
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
Iris Miréa-Grivel
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France
Bruno Millet
Affiliation:
Department of Adult Psychiatry, boulevard de l'Hôpital, Hôpital Universitaire de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de, Paris 75013, France
Emmanuel Gérardin
Affiliation:
Department of Neuroradiology, Rouen University Hospital, Rouen, France
Vincent Compère
Affiliation:
Department of Anaesthesiology and Intensive Care, Rouen University Hospital, Rouen, France
Sonia Dollfus
Affiliation:
UNICAEN, ISTS, EA 7466, GIP Cyceron, Caen 14000, France CHU de Caen, Service de Psychiatrie adulte, Caen 14000, France UFR Santé UNICAEN, 2 rue des Rochambelles, Caen 14000, France
Nemat Jaafari
Affiliation:
Centre Hospitalier Henri Laborit, Poitiers, France
Jacques Bénichou
Affiliation:
Department of Biostatistics, Rouen University Hospital, Rouen, France INSERM U 1018, University of Rouen, Rouen, France
Caroline Thill
Affiliation:
Department of Biostatistics, Rouen University Hospital, Rouen, France
Olivier Guillin
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France Rouen University Hospital, Rouen, France INSERM U 1245 University of Rouen, Rouen, France Faculté de Médecine, Normandie University, Rouen, France
Virginie Moulier*
Affiliation:
University Department of Psychiatry, Centre d'Excellence Thérapeutique- Institut de Psychiatrie-Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France EPS Ville Evrard, Unité de Recherche Clinique, Neuilly-sur-Marne, France
*
Authors for correspondence: Maud Rothärmel, E-mail: maud.rotharmel@ch-lerouvray.fr; Virginie Moulier, E-mail: virginie.moulier@ch-lerouvray.fr
Authors for correspondence: Maud Rothärmel, E-mail: maud.rotharmel@ch-lerouvray.fr; Virginie Moulier, E-mail: virginie.moulier@ch-lerouvray.fr
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Abstract

Background

Electroconvulsive therapy (ECT) is one of the most effective treatments for treatment-resistant depression (TRD). However, due to response delay and cognitive impairment, ECT remains an imperfect treatment. Compared to ECT, repetitive transcranial magnetic stimulation (rTMS) is less effective at treating severe depression, but has the advantage of being quick, easy to use, and producing almost no side effects. In this study, our objective was to assess the priming effect of rTMS sessions before ECT on clinical response in patients with TRD.

Methods

In this multicenter, randomized, double-blind, sham-controlled trial, 56 patients with TRD were assigned to active or sham rTMS before ECT treatment. Five sessions of active/sham neuronavigated rTMS were administered over the left dorsolateral prefrontal cortex (20 Hz, 90% resting motor threshold, 20 2 s trains with 60-s intervals, 800 pulses/session) before ECT (which was active for all patients) started. Any relative improvements were then compared between both groups after five ECT sessions, in order to assess the early response to treatment.

Results

After ECT, the active rTMS group exhibited a significantly greater relative improvement than the sham group [43.4% (28.6%) v. 25.4% (17.2%)]. The responder rate in the active group was at least three times higher. Cognitive complaints, which were assessed using the Cognitive Failures Questionnaire, were higher in the sham rTMS group compared to the active rTMS group, but this difference was not corroborated by cognitive tests.

Conclusions

rTMS could be used to enhance the efficacy of ECT in patients with TRD. ClinicalTrials.gov: NCT02830399.

Keywords

Cognitionelectrical chargeelectroconvulsive therapypriming effectrTMStreatment-resistant depression
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 5 , April 2023 , pp. 2060 - 2071
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

Both authors contributed equally to this manuscript.

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Supplementary material: File

Rothärmel et al. supplementary material

Table S1

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Rothärmel et al. supplementary material

Table S2

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Rothärmel et al. supplementary material

Table S4

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Rothärmel et al. supplementary material

Table S3

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