title: Effect of antipsychotic pharmacotherapy on clinical outcomes of intermittent theta-burst stimulation for refractory depression.
abstract: Theta-burst stimulation is an emerging protocol for repetitive transcranial magnetic stimulation that takes 1-3 min to administer, yet offers equal/superior potency to conventional protocols lasting 30-60 min. However, preclinical evidence suggests that D2 receptor blockade may abolish the acute effects of theta-burst stimulation on synaptic facilitation or inhibition. As many patients presenting for repetitive transcranial magnetic stimulation are taking antipsychotic medications as augmentation for treatment-resistant depression, this finding is potentially concerning for the implementation of theta-burst stimulation in clinical settings. Here, we examined whether treatment-resistant depression patients taking antipsychotics have worse outcomes after a course of intermittent theta-burst stimulation. A chart review identified 105 treatment-resistant depression patients who underwent dorsomedial prefrontal-intermittent theta-burst stimulation; clinical outcomes on Hamilton Depression Rating Scale and Beck Depression Inventory were compared for those taking and not taking antipsychotics. The 29 of 105 patients who were taking antipsychotics showed non-significantly better response and remission rates, and non-significantly larger percentage improvements on both scales, with a positive but non-significant correlation between higher antipsychotic dose and larger percentage improvement. Contrary to expectations, outcomes were not significantly worse, and in some analyses trended towards being better, in patients taking antipsychotics. Future randomized controlled studies of repetitive transcranial magnetic stimulation combined with standardized dopaminergic manipulations may be justified and warranted.
authors.affiliation: 1 MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, Canada.|2 Institute of Medical Science, University of Toronto, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Schulze
authors.affiliation: 2 Institute of Medical Science, University of Toronto, Canada.|3 Department of Psychiatry, University of Toronto, Canada.|4 Centre for Addiction and Mental Health (CAMH), Canada.|5 Department of Psychological Clinical Sciences, University of Toronto, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Remington
authors.affiliation: 1 MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, Canada.|3 Department of Psychiatry, University of Toronto, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Giacobbe
authors.affiliation: 2 Institute of Medical Science, University of Toronto, Canada.|3 Department of Psychiatry, University of Toronto, Canada.|6 Krembil Research Institute, University Health Network, Canada.
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.affiliation: 3 Department of Psychiatry, University of Toronto, Canada.|7 Campbell Family Mental Health Research Institute and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blumberger
authors.affiliation: 2 Institute of Medical Science, University of Toronto, Canada.|3 Department of Psychiatry, University of Toronto, Canada.|7 Campbell Family Mental Health Research Institute and Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Canada.
authors.forename: Zafiris J
authors.initials: ZJ
authors.lastname: Daskalakis
authors.affiliation: 1 MRI-Guided rTMS Clinic, Department of Psychiatry, University Health Network, Canada.|2 Institute of Medical Science, University of Toronto, Canada.|3 Department of Psychiatry, University of Toronto, Canada.|6 Krembil Research Institute, University Health Network, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Downar
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000187:drug effects; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D013826:Theta Rhythm / Q000187:drug effects; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents
keywords: Antipsychotic; depression; dopamine; neurostimulation; rTMS