25th October 2019, Volume 132 Number 1504

Kate EM Godfrey, Suresh D Muthukumaraswamy, Cathy M Stinear, Nicholas R Hoeh

Major depressive disorder (MDD), as described in the DSM 5, is the most prevalent mental health disorder in New Zealand. It affects at least 5.3 % of the population and…

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Summary

A significant number of people in New Zealand struggle with clinical depression. People with clinical depression have difficulties with employment, maintaining healthy relationships, and have an in-creased risk of suicide. Many people with clinical depression do not respond to treatments with multi-ple trials of medications and talk therapy. Treatment with repetitive transcranial magnetic stimulation (rTMS) is established as a helpful and safe treatment which is widely available internationally. Addi-tionally, rTMS can be safely used in combination with other types of treatment. However, currently the majority of the New Zealand population has almost no realistic way to access rTMS treatment. This study demonstrates that treatment with rTMS can be helpful and safely provided to many people in New Zealand struggling with clinical depression.

Abstract

Aim

Major depressive disorder (MDD) poses a significant and growing burden on the New Zealand population. It is a leading cause of disability, and resistance to currently offered treatments is common. Repetitive transcranial magnetic stimulation (rTMS) is a treatment offered internationally demonstrating good efficacy and few reports of side effects. It is an intervention that requires daily visits to a clinic over a period of at least four weeks. This study aimed to investigate the effectiveness and acceptability of offering rTMS as a treatment for MDD in the setting of New Zealand healthcare systems.

Method

This was a naturalistic, open-label pilot study in which 30 patients with moderate-to-severe treatment-resistant MDD were treated with a course of rTMS (10 Hz) daily over the left dorsolateral prefrontal cortex for four weeks (20 sessions). Primary endpoint was response to treatment, stratified into non-responder, partial responder or responder based on the Montgomery–Åsberg Depression Rating Scale (MADRS) at the end of treatment compared to baseline (<25% reduction, 25–50% reduction, and >50% reduction respectively). Participant remission was also noted as reaching a score of ≤10.

Results

Thirty participants completed the full course of treatment (16 women, mean age 47y, range 19–77y), with a mean baseline MADRS of 32.0 (range 21–48). Twelve participants were classified as responders, six as partial responders, and 12 as non-responders. Of the responders, nine were in remission at the end of treatment. Minimal side effects were reported.

Conclusion

Daily sessions of rTMS were successfully administered and were effective in treatment-resistant MDD. The treatment was accessible and well tolerated by the majority of the study participants and should be made available to MDD patients in New Zealand as a treatment option.

Author Information

Kate EM Godfrey, PhD Candidate, School of Pharmacy, The University of Auckland, Auckland;
Suresh D Muthukumaraswamy, Associate Professor, School of Pharmacy, The University of Auckland, Auckland; Cathy M Stinear, Professor, School of Medicine, The University of Auckland, Auckland; Nicholas R Hoeh, Psychiatrist, Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland.

Acknowledgements

This research was funded by an Oakley Mental Health Research Foundation grant. We thank Stephanie Nuysink, Karen Smith, Ashley Sorenson, Michelle Farr and Sarah McGrannachan for help with data collection.

Correspondence

Dr Nicholas R Hoeh, Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142.

Correspondence Email

n.hoeh@auckland.ac.nz

Competing Interests

All authors report grants from Oakley Mental Health Research Foundation during the conduct of the study.

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