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No. 4 (2023)

ORIRGINAL RESEARCH

Application of Transcranial Magnetic Stimulation (TMS) in Combination with Antidepressants for Treatment-Resistant depressions in patients with schizophrenia

https://doi.org/10.21265/PSYPH.2023.56.66.002

Published 2023-12-30

  • N.V. Maslenikov
    • ,
  • E.E. Tsukarzi
    • ,
  • S.N. Mosolov

N.V. Maslenikov
Moscow Research Institute of Psychiatry — branch of the V.P. Serbsky National Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation

E.E. Tsukarzi
Moscow Research Institute of Psychiatry — branch of the V.P. Serbsky National Medical Research Center for Psychiatr y and Narcology of the Ministry of Health of the Russian Federation

S.N. Mosolov
Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation

Abstract

Background. Depression is the most common co-occurring syndrome in patients with schizophrenia, which deteriorates quality of life and disease outcome. Insufficient clinical response to adequate pharmacotherapy determines rising interest to brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS).
Objective. To evaluate efficacy and safety of rTMS for treatment-resistant depression in patients with schizophrenia and to determine possible predictors of response.
Methods. The study included 31 patients with schizophrenia with prominent negative symptoms and depression (CDSS ≥ 6) who received continuous combined pharmacotherapy (effective antipsychotic + ineffective antidepressant of the 2nd line) in adequate dosage regimen and exposition. Patients received 15-Hz rTMS on the left dorsolateral prefrontal cortex (100 % intensity, 15 sessions of 1800 pulses). Neuro-MS/D stimulator (“Neurosoft”, Russia) with 8-shaped coil was used. Patients were assessed with CDSS and PANSS scales weekly. The criterion of efficacy was 50 % CDSS score reduction after the 3rd week of treatment.
Results. The number of responders was 20 (64,5 %), mean CDSS score reduction was 55,2 % (p = 0,000 004), mean PANSS negative subscale score reduction was 21,3 % (p = 0,000 012). Rapid onset of rTMS effect on depressive symptoms was detected: mean CDSS score reduction after the 1st week of treatment was 39,0 % (p = 0,000 004). Positive outcome of rTMS was associated with marked motor retardation and residual psychotic symptoms at the baseline and with feminine gender. Patients with severe negative symptoms showed tendency to poor response.
Conclusions. The study revealed that rTMS is effective and safe strategy for the management of treatment-resistant depression in patients with schizophrenia. Further sham-controlled studies are needed.

Keywords

transcranial magnetic stimulation, TMS, depression, schizophrenia, treatment-resistance, negative symptoms

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