Journal: Brain Stimulation 14 (2021) 658-661
Authors: A. Tendler, Y. Roth, T. Harmelech
Background:
OCD patients frequently have additional psychiatric illness, the most common being MDD. In 2018 the FDA cleared Deep TMS H7 Coil for the treatment of refractory OCD, based on the efficacy results of a multicenter study. The H7 Coil and its stimulation target (dorsomedial prefrontal and cingulate cortices) are significantly different from the H1 Coil that stimulates primarily the left dorsolateral prefrontal cortex and is cleared for the treatment of refractory MDD.
Objective:
Investigate whether patients with comorbid MDD and OCD would require two different TMS treatments, with the H1 and H7 respectively, or would the OCD treatment with the H7 also treat their MDD.
Methods:
All sites with H-Coils are solicited to participate in post marketing data collection. This population was required to have had a diagnosis of OCD, outcome measures with the Yale Brown Obsessive Compulsive Scale (YBOCS), a comorbid diagnosis of at least moderate MDD with any of several rating scales, and treatment with the H7 coil and not any additional coils. Depression severity inclusion criteria was defined as a Hamilton depression rating scale (HDRS) Total Score>16, the Patient Health Questionnaire-9 (PHQ-9) Total Score>10, the Beck Depression Inventory-II (BDI-II) Total Score>20 and the Inventory of Depressive Symptomatology- Self Report (IDS-SR) Total Score>24. At every time point, the average percent change in all the available MDD scores was determined and used for analysis.
Results:
A total of 59 OCD patients (YBOCS>20) with at least moderate MDD at baseline were treated with H7 Coil. A significant decrease was seen in both YBOCS and MDD scores after 5 Deep TMS sessions and at any timepoint beyond. After 30 sessions, YBOCS score decreased on average by 30% and MDD scores by 38%, with the vast majority (71.4%) of patients demonstrating benefit from treatment in both disorders. A continuous improvement was seen upon further Deep TMS sessions up to 40 sessions. A highly significant correlation was found between YBOCS and MDD scores change (p<0.0001, Spearman r=0.3923).
Conclusions:
The results corroborate our previous finding in a larger sample and further elucidate the underlying mechanism of the demonstrated improvement in MDD following OCD treatment with the H7 Coil. While it could be argued that the improvement in MDD is simply an indirect result of alleviating the OCD symptoms, a more compelling hypothesis is that the stimulation over the DMPFC-ACC directly improves MDD symptoms irrespective of the OCD.
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