Magnetic brain stimulation (rTMS) combined with concurrent psychotherapy is found to be more effective, then either technique alone, as has been published in the international journal ‘Brain Stimulation’ based on a study in 196 patients.
After an average of 21 sessions, 66% of patients with treatment-resistant depression responded well to treatment, with lasting effects after 6 months in 65% of this group.
rTMS: an effective add-on for psychotherapy
Studies show that when either rTMS or Psychotherapy are conducted as a monotherapy, an average of 30-40% of patients achieve remission, clearly less than the 56% remission achieved with the combined treatment of rTMS and psychotherapy. Similarly, it is widely known that ‘psychotherapy and drugs’ combined show better outcomes, however, this approach often requires two separate treatment programs and specialists, i.e. a Psychiatrist to deliver medications and a Psychologist to deliver Psychotherapy. A combined approach of Psychotherapy at the same time as brain stimulation can be performed by one clinician and is shown to be more efficient, and above all, a more effective treatment for treatment-resistant Depression.
Recognition
How does rTMS and Psychotherapy work in combination?
Research has shown that depression is linked to disrupted communication in a specific network of brain structures including the frontal cortex (dorsolateral prefrontal cortex (DLPFC)) and the deeper anterior cingulate (sgACC). rTMS focuses specifically on the DLPFC and indirectly stimulates the sgACC transsynaptically, as demonstrated in previous research on NCG-TMS 2). Psychotherapy is understood to also activate the deeper sgACC in this network (among other areas) more directly. It is therefore seen that concurrent application of these techniques then activates a larger part of a malfunctioning ‘depression network’, with higher clinical efficacy.
References:
1) Donse, L., Padberg, F., Sack, A. T., Rush, A. J., & Arns, M. (2017). Simultaneous rTMS and psychotherapy in major depressive disorder: Clinical outcomes and predictors from a large naturalistic study. Brain Stimulation. doi: https://doi.org/10.1016/j.brs.2017.11.004
2) Iseger, T. A., Padberg, F., Kenemans, J. L., Gevirtz, R., & Arns, M. (2017). Neuro-Cardiac-Guided TMS (NCG-TMS): Probing DLPFC-sgACC-vagus nerve connectivity using heart rate-first results. Brain Stimulation. doi: http://dx.doi.org/10.1016/j.brs.2017.05.002