Assessing the Efficacy of Repetitive Transcranial Magnetic Stimulation in the Management of Treatment Resistant Depression: A Scoping Review

Introduction Treatment-resistant depression (TRD) is the failure to accomplish and/or achieve remission after an adequate trial of different classes of antidepressant treatments. TRD presents with significant disability and high prevalence. It results in a substantive socio-economic burden at the community and global levels. TRD. Studies comparing pharmacotherapy and electroconvulsive therapy with repetitive transcranial magnetic stimulation (rTMS) have demonstrated evidence in support of the therapeutic efficacy of rTMS in TRD. Objectives This comprehensive scoping review aimed to explore and garner information in the literature regarding the crucial role of rTMS and its therapeutic efficacy as a treatment modality for TRD. Methods Electronic data searches in PubMed, PsycINFO, Medline, Embase, and Cinahl were conducted to identify important articles on rTMS for TRD. The data search strategy was limited to articles written in English and published within the last five years, to the date of the data search (February 2022). Articles were reviewed if they reported on a completed randomized controlled trial of rTMS treatment in TRD. Articles were excluded if they were protocols of rTMS on TRD and studies with rTMS for the treatment of conditions other than TRD. The review process was reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Results In total, 17 studies met the eligibility criteria for this review. The geographical breakdown of the extracted studies consisted of North America (n = 9), Europe (n = 5), Asia (n = 2), and Australia (n = 1). The frequencies of rTMS applied in the various studies ranged from 5 Hz to 50 Hz, with stimulation intensities ranging from 80% MT to 120% MT. Overall, 16 out of the 17 studies demonstrated evidence that suggested rTMS treatment was effective, safe, and tolerated in the management of patients with TRD. Conclusions Overall, rTMS appeard to provide significant therapeutic benefits for patients with TRD through the reduction of depressive symptoms. However, while there is progressive evidence in support of rTMS in TRD, more research is needed to define the standardized protocols of rTMS application in terms of localization, frequency, intensity, and pulse parameters to realize its full potency in TRD. Disclosure of Interest None Declared

Introduction: Chronic diseases are a public health problem and high prevalent on depressed patients.Objectives: To describe the sociodemographic characteristics and the quality of life of a sample of depressed patients with hypertension and oder diabetes as comorbidity.Methods: It is the baseline evaluation of 361 persons participating in a clinical trial that studies the effectiveness of a psychoeducational intervention for this type of patients.Persons with moderate or severe depression and with hypertension and or diabetes attending 8 primary care centers in Santiago were invited to participate .

Results:
The sample consisted of 361 study participants,the majority female(89.97%).The mean age was 59.81 years(de=10.28),withan age range observed from 26 to 83 years.Most of the participants had primary(35,91%)or secondary (43.21%)education level.More than a third of the participants reported houshold chores(34.09%)and a quarter were working for income(28.41%).About half of the participants were married(44.48%).The mean PHQ-9 score was 18.73(sd=2.81).Most of the participants had a previous diagnoses of depression(60.39%).The sample obtained an average of 34.99 points(sd=20.82) in the mental health component of the 12-item Short Form Health Survey indicative of poor quality of life related to mental health.Conclusions: Depressed patients with chronic diseases ,users of primary care clinics, have poor quality of life,so it is urgent to review care protocols to achieve better health results.

EPV0438
Assessing the Efficacy of Repetitive Transcranial Magnetic Stimulation in the Management of Treatment Resistant Depression: A Scoping Review Introduction: Treatment-resistant depression (TRD) is the failure to accomplish and/or achieve remission after an adequate trial of different classes of antidepressant treatments.TRD presents with significant disability and high prevalence.It results in a substantive socio-economic burden at the community and global levels.TRD.Studies comparing pharmacotherapy and electroconvulsive therapy with repetitive transcranial magnetic stimulation (rTMS) have demonstrated evidence in support of the therapeutic efficacy of rTMS in TRD.Objectives: This comprehensive scoping review aimed to explore and garner information in the literature regarding the crucial role of rTMS and its therapeutic efficacy as a treatment modality for TRD.Methods: Electronic data searches in PubMed, PsycINFO, Medline, Embase, and Cinahl were conducted to identify important articles on rTMS for TRD.The data search strategy was limited to articles written in English and published within the last five years, to the date of the data search (February 2022).Articles were reviewed if they reported on a completed randomized controlled trial of rTMS treatment in TRD.Articles were excluded if they were protocols of rTMS on TRD and studies with rTMS for the treatment of conditions other than TRD.The review process was reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR).Results: In total, 17 studies met the eligibility criteria for this review.The geographical breakdown of the extracted studies consisted of North America (n = 9), Europe (n = 5), Asia (n = 2), and Australia (n = 1).The frequencies of rTMS applied in the various studies ranged from 5 Hz to 50 Hz, with stimulation intensities ranging from 80% MT to 120% MT.Overall, 16 out of the 17 studies demonstrated evidence that suggested rTMS treatment was effective, safe, and tolerated in the management of patients with TRD.
Conclusions: Overall, rTMS appeard to provide significant therapeutic benefits for patients with TRD through the reduction of depressive symptoms.However, while there is progressive evidence in support of rTMS in TRD, more research is needed to define the standardized protocols of rTMS application in terms of localization, frequency, intensity, and pulse parameters to realize its full potency in TRD.Introduction: Despite several treatment strategies for treatmentresistant depression (TRD) exist, including the use of repetitive transcranial magnetic stimulation (rTMS), new therapeutic options are being introduced.Text4Support is a form of cognitive behavior therapy that allows patients with depression to receive daily supportive text messages that seek to correct or alter negative thought patterns through positive reinforcement.Text4Support is deemed a useful augmentation treatment strategy for patients with TRD.It is however currently unknown if adding the Text4Support intervention will enhance patients with TRD's response to rTMS treatments Objectives: This study aims to assess the initial comparative clinical effectiveness of rTMS when used with and without the Text4Support program as an innovative patient-centered intervention for the management of participants diagnosed with TRD.Methods: This study is a multicentered prospective, paralleldesign, two-arm, rater-blinded randomized controlled pilot trial.In total, 200 participants diagnosed with TRD will be randomized to one of two treatment arms (rTMS alone and rTMS with Text4-Support).Participants in each arm will be made to complete evaluation measures at baseline, 1,3, and 6 months.The primary outcome measure will be the mean change to scores on the Hamilton Depression Rating Scale.Patient service utilization data and clinician-rated measures will also be used to gauge patient progress.Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses.Results: The result of the study is expected to be available 18 months after the start of recruitment.We hypothesize that participants enrolled in the rTMS plus Text4Support intervention will achieve superior outcomes compared with participants enrolled in the rTMS treatment alone.Conclusions: The concomitant application of the combination of these two treatment techniques has not been investigated previously.Therefore, we hope that this project will provide a concrete base of data to evaluate the practical application and efficacy of using a novel combination of these two treatment modalities.Objectives: This paper aims to evaluate the effectiveness, feasibility, and user satisfaction of daily supportive email messaging as a noninferior intervention compared to daily supportive text messaging as an add-on treatment for patients with depression.Methods: This trial will be carried out using a hybrid type II implementation-effectiveness design.In addition to the usual care, patients with depression will be randomized to receive either supportive text messages or supportive email messages.The messages in both groups will have the same content and will be provided daily for 6 months.The implementation evaluation will be guided by the Consolidated Framework for Implementation Research and the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.Descriptive and inferential statistics will be employed in the analysis of the quantitative outcome measures, while thematic analysis will be used for Qualitative data.Results: The results are expected to be available 18 months after the start of recruitment.The results will highlight the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with depression as noninferior to text messaging.Conclusions: The outcome of this trial will have a translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation.

EPV0441
Risk factors for psychiatric readmission among inpatients with major depressive disorder: A patientchart based study Interest: None Declared EPV0439 Adjunctive Therapy of Text4Support for Treatment-Resistant Depression Patients Receiving Repetitive Transcranial Magnetic Stimulation.A Multicenter Randomized Controlled Pilot Trial Interest: None Declared EPV0440 Comparative Effectiveness of Daily Supportive Text Messages Versus Email Messages for Patients with Depression.Randomized Hybrid Type II Effectiveness-Implementation Trial M. K. Adu 1 *, R. Shalaby 2 , E. Eboreime 2 and V. Agyapong 1 Introduction: Background: Major depressive disorder (MDD) is a global health problem accounting for about 40.5% of disabilityadjusted life years caused by mental and substance use disorders.Barriers to accessing healthcare services have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions.Several clinical trials have proven the effectiveness of supportive SMS text messaging in ameliorating depressive symptoms, however, this approach can only be accessible to individuals having cell phones.