Table 1:
Clinical Trials investigating the use of rTMS for depressive symptoms following concussion
| Publication | N (Concussion+Depression) | Age in Years (Mean, Standard Deviation) | Gender (Male/Female) | Population | Protocol | Number of Sessions, Frequency of Sessions | Blinding | Depression Outcome Measure | Reported Effects for Depression Outcome Measure | Side-Effects/Adverse Events |
|---|---|---|---|---|---|---|---|---|---|---|
|
Fitzgerald et al., 2011 Journal of ECT |
1 | 41 | 1 Female | Civilian-Car Accident | R-DLPFC (structural MRI targeting): 900 pulses at 110% MT at 1 Hz Followed by L-DLPFC (structural MRI targeting): 1500 pulses at 110% MT at 10 Hz, 5 second train duration, 25 second intertrain interval | 20, 1 session/day | None | MADRS | 50% Reduction in MADRS Score | None Reported |
|
George et al., 2014 Brain Stimulation |
24 (13 active, 11 sham) | M=42.5, SD=15.5 | Approx. 20/4 (subset of the overall sample) | Military/Veteran | L-DLPFC (6 cm anterior to M1 scalp targeting): 6000 pulses at 110% MT at 10 Hz, 5 second train duration, 10 second intertrain interval | 9, 3 sessions/day with 1 hour intersession interval. | Double Blind | HAM-D, MADRS | No significant group difference in HAM-D or MADRS | First-degree scalp burn from coil overheating (n=1) |
|
Leung et al., 2018 Neuromodulation |
29 (14 active, 15 sham) | M=34.1 SD=7.9 | 23/6 | Veteran | L-DLPFC (structural MRI targeting): 2000 pulses at 80% MT at 10 Hz, 10 second train duration, 1 second intertrain interval | 4, 1 session/day | Double Blind | HAM-D | Significant Reduction in HAM-D Score in active group. No significant change in sham group | None Reported |
|
Philip et al., 2019 American Journal of Psychiatry |
12 (7 20 sessions of active, 5 10 sessions of sham, 10 sessions of active) | M=52 SD=10 | 11/1 | Veteran | R-DLPFC (F4 scalp targeting): 1,800 pulses at 80%MT iTBS (3 pulse burst of 50 Hz with a 200ms interburst interval for 10 bursts with an 8 second intertrain interval) | 10 1 session/day | Double Blind | IDS-SR | Significant Reduction in IDS-SR in active group. No significant change in sham group | Active: drowsiness (n=1), anxiety (n=1), headache (n=1) and dizziness (n=1), Sham: homicidal ideation (n=1), death due to fentanyl/alcohol overdose during the follow up period |
|
Siddiqi et al., 2019 Journal of Neurotrauma |
14 (9 active, 5 sham) | M=45.5 SD=14.4 | 11/3 | Mixed Sample (2 military) | L-DLPFC (rsfMRI targeting): 4000 pulses at 120% MT at 10 Hz, 5 second train duration, 20 second intertrain interval Followed by R-DLPFC (rsfMRI targeting): 1000 pulses at 120% MT at 1 Hz | 20, 1 session/day | Double Blind | MADRS | 56% Reduction in MADRS score in active group, 27.5% Reduction in MADRS score in sham group | Active: transient twitching and discomfort in the facial muscles (n=7), worsening headache (n=1), presyncopal episode (n=1) Sham: worsening headache (n=1) |
|
Hoy et al., 2019 Journal of Neurotrauma |
12 (7 active, 5 sham) | M=45.7 SD=11.4 | Approx. 6/6 (subset of the overall sample) | Not reported, Academic Medical Center | R-DLPFC (structural MRI targeting): 900 pulses at 110% MT at 1 Hz Followed by L-DLPFC (structural MRI targeting): 1500 pulses at 110% MT at 10 Hz, 5 second train duration, 25 second intertrain interval | 20, 1 session/day | Double Blind | MADRS | Significant Reduction in MADRS Score across both groups. No group difference | Active: 72% Sham: 30% one or more of the following: site discomfort, mild headache, severe headache, both headache and site discomfort |
|
Rao et al., 2019 Journal of Neuropsychiatry & Clinical Neurosciences |
28 (13 active, 15 sham) | M=40.0 SD=14.4 |
Approx. 11/17 (subset of the overall sample) | Not Reported, Academic Medical Center and Department of Defense | R-DLPFC (F4 scalp targeting): 1200 pulses at 110% MT at 1 Hz, 300 second train duration, 60 second intertrain interval | 20, 1 session/day | Double Blind | HAM-D | Significant Reduction in HAM-D Score across both groups. No group difference | Active: headache (n=Approx. 7), dizziness (n=1), blurred vision (n=1), fatigue (n=1), puffy face (n=1) Sham: headache (n=Approx. 8) |
R-DLPFC=Right Dorsolateral Prefrontal Cortex; L-DLPFC=Left Dorsolateral Prefrontal Cortex; cm=centimeters; MADRS=Montgomery Asberg Depression Scale; HAM-D=Hamilton Depression Rating Scale; IDS-SR= Inventory of Depressive Symptoms-Self Report; MRI=Magnetic Resonance Imaging; rsfMRI=Resting State Functional Connectivity Magnetic Resonance Imaging; F4=10-20 scalp-based definition of right dorsolateral prefrontal cortex