Clinical Predictors Associated with Duration of repetitive Transcranial Magnetic Stimulation Treatment for Remission in Bipolar Depression: A Naturalistic Study
Cohen RB, Brunoni AR, Boggio PS, Fregni F
Source: Centro Brasileiro de Estimulacao Magnetica Transcraniana, Sao Paulo, Brazil.
ABSTRACT
Repetitive transcranial magnetic stimulation (rTMS) has been widely tested and shown to be
effective for unipolar depression. Although it has also been investigated for bipolar depression
(BD), there are only few rTMS studies with BD. Here, we investigated 56 patients with BD who
received rTMS treatment until remission (defined as Hamilton Depression Rating Scores < or =7).
We used simple and multiple logistic regressions to identify clinical and demographic predictors
associated with duration of treatment (defined as <15 vs. >15 rTMS sessions). Age,
refractoriness, number of prior depressive episodes, and severe depression at baseline were
associated with a longer rTMS treatment. In the multivariate analysis, refractoriness (likelihood
ratio (LR) = 4.33; p < 0.01) and baseline severity (LR = 0.18, p < 0.01) remained significant
predictors. Our preliminary study showed that, in remitted patients, refractoriness and severity of
index episode are associated with the need of a longer rTMS treatment; providing preliminary
evidence of important factors associated with rTMS parameters adjustment.