Treating Depression in Multiple Sclerosis with Transcranial Magnetic Stimulation: A Pilot Study
Peter Giacobbe, Alycia Bennett, Sean Nestor, Dorsa Derakhshan, Clement Hamani, Nir Lipsman, Anthony FeinsteinABSTRACT
Background:
Depression is two to three times more common in people with multiple sclerosis (pwMS) than the general population.
Objective:
To evaluate the efficacy and tolerability of intermittent theta burst stimulation (iTBS) in treating depressive symptoms in pwMS and major depressive disorder (MDD).
Methods:
Twenty-one pwMS and MDD participated in an open-label 4-week trial of iTBS to the left dorsolateral prefrontal cortex (L-DLPFC). The Hamilton Depression Rating Scale (HAMD-17), California Verbal Learning Test Second Edition Total Learning (CVLT-II-TL), Brief Visuospatial Memory Test – Revised Total Learning (BVMT-R-TL) and Symbol Digit Modalities Test (SDMT) were administered before and after treatment. The primary outcome was response rates on HAMD-17, defined as a >50% reduction from baseline.
Results:
Depression scores decreased from baseline to post-treatment with a mean reduction of 10.24 points (d = 1.55, 95% CI 0.83 to 2.25, P < .001). Ten (58.8%) pwMS responded to treatment, and seven (41.2%) were non-responders (n = 17). The treatment response group showed lower depression scores post-treatment than non-responders (d = −3.01, 95% CI −4.43 to −1.55, P < .001). Post-treatment, responders showed higher visuospatial memory (d = 1.11, 95% CI 0.06 to 2.14, P = .039) and information processing scores (d = 1.74, 95% CI 0.58 to 2.87, P = .003) compared to non-responders. There were two drop-outs, and two participants were lost to follow-up. There were no serious adverse events.
Conclusions:
iTBS can improve depressive symptoms in pwMS and MDD and may be associated with cognitive improvement.
Clinical trial registration:
NCT04621708.