title: Improvement of health-related quality of life in depression after transcranial magnetic stimulation in a naturalistic trial is associated with decreased perfusion in precuneus.
abstract: BACKGROUND
  Assessing Health-related Quality of life (HRQoL) is necessary to evaluate care and treatments provided to patients with major depressive disorder (MDD), in addition to the traditional assessment of clinical outcomes. However, HRQoL remains under-utilized to assess the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in research or in a routine clinical setting. The primary objective of this exploratory study on MDD was to investigate the impact of low-frequency rTMS on HRQoL using the SF-36 questionnaire. A secondary objective was to study the functional neural substrate underlying HRQoL changes using neuroimaging.
  
  
  METHODS
  Fifteen right-handed patients who met DSM-IV criteria for MDD participated in the study. HRQoL was assessed using the SF-36, and regional cerebral blood (rCBF) flow using 99mTc-ECD-SPECT. Voxel based correlation was searched between concomitant changes in rCBF and in HRQoL after rTMS.
  
  
  RESULTS
  Role-Physical Problems dimension showed a statistical significant improvement of 73.2% (p = 0.001) and an effect size (Cohen's d) of 0.43, indicating moderate effect. Five SF-36 dimension scores and the two composite scores showed effect sizes ranged from 0.28 to 0.43. Improvement of Mental Composite Score (MCS)-SF-36 after rTMS was correlated with a concomitant decrease of precuneus perfusion (p < 0.001). Post-hoc analyses confirmed that decreased perfusion in precuneus was correlated with improvement of HRQoL, especially for MCS (r = -0.71; p < 0.001), Mental Health (r = -0.81; p < 0.001) and Social Functioning (r = -0.57; p = 0.026) dimensions.
  
  
  CONCLUSIONS
  This study suggests low-frequency rTMS can improve HRQoL, through its role-physical problems dimension, in patients with MDD. This improvement is associated with a decreased perfusion of the precuneus, a brain area involved in self-focus and self-processing, arguing for a neural substrate to the impact of rTMS on HRQoL.
authors: Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille 13009, France. remy.dumas@ap-hm.fr
authors: Rémy
authors: R
authors: Dumas
authors: Raphaëlle
authors: R
authors: Richieri
authors: Eric
authors: E
authors: Guedj
authors: Pascal
authors: P
authors: Auquier
authors: Christophe
authors: C
authors: Lancon
authors: Laurent
authors: L
authors: Boyer
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018692:Antimanic Agents / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000000981:diagnostic imaging; D061218:Depressive Disorder, Treatment-Resistant / Q000000981:diagnostic imaging; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004359:Drug Therapy, Combination; D005260:Female; D005602:France; D059907:Functional Neuroimaging / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D050781:Transcranial Magnetic Stimulation / Q000528:radiation effects; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D018692:Antimanic Agents