title: Antidepressant effectiveness of deep Transcranial Magnetic Stimulation (dTMS) in patients with Major Depressive Disorder (MDD) with or without Alcohol Use Disorders (AUDs): a 6-month, open label, follow-up study.
abstract: BACKGROUND
  Co-occurrence of Major Depressive (MDD) and Alcohol Use Disorders (AUDs) is frequent, causing more burden than each disorder separately. Since the dorsolateral prefrontal cortex (DLPFC) is critically involved in both mood and reward and dysfunctional in both conditions, we aimed to evaluate the effects of dTMS stimulation of bilateral DLPFC with left prevalence in patients with MDD with or without concomitant AUD.
  
  
  METHODS
  Twelve MDD patients and 11 with concomitant MDD and AUD (MDD+AUD) received 20 dTMS sessions. Clinical status was assessed through the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impressions severity scale (CGIs), craving through the Obsessive Compulsive Drinking Scale (OCDS) in MDD+AUD, and functioning with the Global Assessment of Functioning (GAF).
  
  
  RESULTS
  There were no significant differences between the two groups in sociodemographic (age, sex, years of education and duration of illness) and baseline clinical characteristics, including scores on assessment scales. Per cent drops on HDRS and CGIs scores at the end of the sessions were respectively 62.6% and 78.2% for MDD+AUD, and 55.2% and 67.1% for MDD (p<0.001). HDRS, CGIs and GAF scores remained significantly improved after the 6-month follow-up. HDRS scores dropped significantly earlier in MDD+AUD than in MDD LIMITATIONS: The small sample size and factors inherent to site and background treatment may have affected results.
  
  
  CONCLUSIONS
  High frequency bilateral DLPFC dTMS with left preference was well tolerated and effective in patients with MDD, with or without AUD. The antidepressant effect of dTMS is not affected by alcohol abuse in patients with depressive episodes. The potential use of dTMS for mood modulation as an adjunct to treatment in patients with a depressive episode, with or without alcohol abuse, deserves further investigation.
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Rapinesi
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Bipolar & Psychotic Disorders Program, McLean Hospital, Belmont, MA, USA.
authors.forename: Martina
authors.initials: M
authors.lastname: Curto
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy. Electronic address: giorgio.kotzalidis@uniroma1.it.
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Kotzalidis
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Department of Psychiatric Rehabilitation, P. Alberto Mileno Onlus Foundation, Vasto, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Del Casale
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Serata
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors.forename: Vittoria Rachele
authors.initials: VR
authors.lastname: Ferri
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Di Pietro
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Scatena
authors.affiliation: Department of Neurology and Psychiatry, Policlinico Umberto I University Hospital, Sapienza University, Rome, Italy.
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Bersani
authors.affiliation: ATID Ltd. Advanced Technology Innovation Distribution, Rome, Italy.
authors.forename: Ruggero Nessim
authors.initials: RN
authors.lastname: Raccah
authors.affiliation: Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Digiacomantonio
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferracuti
authors.affiliation: Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bersani
authors.affiliation: Department of Life Sciences, Ben Gurion University of the Negev, Be׳er Sheva, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Zangen
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Angeletti
authors.affiliation: NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, Sapienza University of Rome, School of Medicine and Psychology, Sant׳Andrea Hospital, Rome, Italy; Alcohology Service, Villa Rosa, Suore Ospedaliere of the Sacred Heart of Jesus, Viterbo, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
mesh_terms: D000328:Adult; D000339:Affect; D000428:Alcohol Drinking; D000437:Alcoholism / Q000150:complications* / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000150:complications* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009770:Obsessive Behavior; D017397:Prefrontal Cortex / Q000503:physiopathology*; D012107:Research Design; D012720:Severity of Illness Index; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D016896:Treatment Outcome
keywords: Alcohol; Depression; Dorsolateral prefrontal cortex (DLPFC); deep Transcranial Magnetic Stimulation (dTMS)