Transitioning From Maintenance ECT to Maintenance TMS in Treatment Resistant Depression
Austin Messner
Summary
Electroconvulsive therapy (ECT) is one of the most efficacious treatments available for treatment-resistant depression (TRD). Although a maintenance ECT protocol exists, multiple barriers limit its use for long-term use. These barriers include procedure tolerability, cognitive side effects, financial burden, and unreliable social support to accompany patients for these treatments. On the other hand, a different modality of noninvasive neuromodulation called transcranial magnetic stimulation (TMS) can be performed in the outpatient setting and does not need anesthesia. The likelihood of cognitive adverse effects with TMS is much lower than with ECT. Our clinical question encompasses piloting a maintenance TMS regimen to maintain remission in treatment-resistant major depressive disorder. This will be a patient-preference clinical trial, with patients offered the choice to initiate maintenance TMS versus maintenance ECT after their index ECT sessions for treatment-resistant depression. There will be no randomization or placebo involved in this study.
Description
The clinical question encompasses piloting a maintenance TMS regimen to maintain remission in treatment-resistant major depressive disorder. Patients who choose maintenance TMS will initiate maintenance TMS sessions on day one of the study and continue any currently prescribed pharmacotherapy. Participants will initiate TMS treatment within 1 week of last index ECT treatment. Participants will then follow a schedule of weekly for 4 sessions, every other week for 4 sessions, and monthly for 3 sessions for a total of 11 sessions in 6 months. Investigators will use the TMS paradigm called interm…
Eligibility
- Age range
- 18–65 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Patients treated for TRD who have achieved remission through an index series of ECT * Able to provide informed consent * Age between 18 and 65 years * Deemed appropriate for maintenance TMS by their psychiatrist * Right-handed Exclusion Criteria: * History of seizures or a seizure disorder * Related neurological disorder, or any other medical condition that would preclude TMS treatment determined by the treatment team.
Interventions
- DeviceTransmagnetic Stimulation
TMS will be given for the maintenance treatment of treatment resistant depression following successful course of ECT (8-12 treatments).
- DeviceElectroconvulsive Therapy
Patients will remain in standard of care treatment and receive maintenance ECT treatments for treatment resistant depression
Location
- University of KentuckyLexington, Kentucky