Table of Contents
Is TMS Useful for the Treatment of Depression?
Initial Comments
Important Point #1 I Declare Victory!!
Important Point #1 I Declare Victory!!
Important Point #1 I Declare Victory!!
Important Point #1 I Declare Victory!!
I Declare Victory
PPT Slide
A Few Other Important Points
PPT Slide
TMS is ‘Electrodeless’ Electrical Stimulation
Important Point #2 TMS is a powerful way to modulate brain circuits
Important Point #3 We are beginning to understand TMS use parameters and translational neurobiology
The Distance from Coil to Cortex Matters
PPT Slide
Higher Intensity TMS Affects Local and Connected Prefrontal Cortex
#4 -TMS Can Effect the Brain in Ways That Modulate Depression Symptoms and Circuits
Prefrontal TMS Effects Limbic Blood Flow
Changes in Regional Brain Perfusion (SPECT) in 8 Adults During Left Prefrontal rTMS Compared to Baseline (20 Hz, 2 secs, 80% MT, 20 mins)
Cingulate’s rCBF increased in TMS responders
Prefrontal TMS Affects Mood Circuits in Depressed Adults
Important Point #5 A Large Body of Studies Demonstrate TMS Antidepressant Efficacy
Initial TMS Antidepressant Studies
PPT Slide
PPT Slide
Does TMS Have Antidepressant Effects Greater than Sham?
Summary of 5 Published RCT TMS Antidepressant Trials n=86 active, 83 placebo, 2 Weeks, Prefrontal
PPT Slide
PPT Slide
TMS compared to other treatments How does the clinical effect compare to other treatments?
TMS Compared to ECT
Conclusions - rTMS Depression Studies
Conclusions - rTMS Depression Studies
Important Point #6 TMS is likely to be a useful treatment for depression
Important Point #6 TMS is likely to be a useful treatment for depression
What’s Left to Debate?
PPT Slide
Does TMS work for depression?
PPT Slide
Criteria for regulatory approval of a new treatment
Criteria for regulatory approval of a new treatment
Criteria for regulatory approval of a new treatment
Criteria for regulatory approval of a new treatment
TMS - sham-controlled studies
TMS - sham-controlled studies II
TMS - sham-controlled studies III
PPT Slide
PPT Slide
PPT Slide
Criteria for regulatory approval of a new treatment
TMS v. active comparator
Response rates to ECT (Janicak, 1985)
Response to antidepressants (US DHHS review, 1993)
Response in treatment resistance (Nelson 1997; Howland, 1997)
Criteria for regulatory approval of a new treatment
Duration of response to rTMS
Criteria for regulatory approval of a new treatment
rTMS for depression - Conclusions I
rTMS for depression - Conclusions II
rTMS for depression - Conclusions III
Rebuttal Slides
Point - There are no good mechanistic theories about how TMS works
How does TMS treat depression?
PPT Slide
TMS as a maintenance tool
PPT Slide
A Single Case of Maintenance TMS 53 yo woman with BPAD depression, previous maintenance with ECT (ᡴ rx)
Maintenance Conclusions
PPT Slide
Allegation: There are no good TMS sham methods
‘Failed’ TMS trials
Development of True Placebo TMS Administration
PPT Slide
|