Elsevier

Brain Stimulation

Volume 5, Issue 4, October 2012, Pages 539-546
Brain Stimulation

Original Article
Investigating the relationship between cognitive change and antidepressant response following rTMS: A large scale retrospective study

https://doi.org/10.1016/j.brs.2011.08.010Get rights and content

Background

The use of repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression has been studied extensively over the last 15 years. In this time the vast majority of trials included assessment of cognition to determine whether the technique is cognitively safe. However, recent evidence suggests that the assessment of cognition could also have an important role to play in the prediction of antidepressant response.

Objectives

The current study conducted a post hoc analysis of the cognitive data from four clinical trials of rTMS for treatment resistant depression, with an aim to investigate the relationship between early cognitive changes and eventual depression improvement.

Method

Data from 137 patients were included in the analysis (62 male and 75 female, mean ages 41.86 ± 11.68 years). The primary outcome measure for all four studies was the Montgomery Asberg Depression Rating Scale (MADRS). Clinical and cognitive assessments were undertaken at baseline, a midtime point, and at endpoint after 4 or 6 weeks of treatment.

Results

There was no cognitive deterioration after a treatment course of rTMS across the four depression trials. Initial improvements in performance on immediate visuospatial memory were significantly related to eventual reduction of depression severity, with visuospatial improvement being a significant predictor of degree of eventual improvement in a near significant regression model.

Conclusions

Traditionally cognitive batteries in rTMS trials are designed to provide a broad assessment of neuropsychological functioning across numerous cognitive domains; however, there is growing evidence that cognition may have a very important role to play as an early indicator of antidepressant response.

Section snippets

Method

The study involved the pooled analysis of data from four clinical trials (Fitzgerald et al., unpublished data).14, 15, 16 Where relevant, only data from participants randomized to active treatment was included. As stated, the aim of the current study was to assess relationships between cognitive change and antidepressant response after rTMS treatment and not the impact of rTMS on cognition per se. Therefore, the pooling of the data allows investigation of these relationships irrespective of the

Results

There were no significant differences on demographic or clinical variables across the four studies (Table 1).

Discussion

There was no cognitive deterioration after a treatment course of rTMS across the four depression trials, with tests of working memory and verbal fluency showing significant improvements after controlling for multiple comparisons. These improvements were not significantly related to reductions in depression severity. With respect to the analyses of early cognitive change, improvement in performance on immediate visuospatial memory was significantly related to eventual reduction of depression

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    K.E.H. was supported by Post Doctoral Training Fellowships from the National Health and Medical Research Council (NHMRC). P.B.F. was supported by a Practitioner Fellowship grant from NHMRC. Z.J.D. was supported by a NARSAD Independent Investigator Award.

    P.B.F. and Z.J.D. have received support for participation in a research study from Neuronetics Ltd. and have no relevant conflicts of interest. K.E.H. and R.A.S. have nothing to disclose.

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