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Repetitive transcranial magnetic stimulation (rTMS) for comorbid major depressive disorder and hoarding disorder: An
Jessica J Zakrzewski1, Lawrence G Appelbaum2, Cory R Weissman2
1Department of Psychiatry, UC San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States.
Insights
Repetitive transcranial magnetic stimulation (rTMS) shows promise for treating Hoarding Disorder (HD) with comorbid Major Depressive Disorder (MDD). This study found rTMS significantly reduced symptoms of both depression and hoarding, improving cognitive function.
Area of Science:
- Neuroscience
- Psychiatry
- Clinical Psychology
Background:
- Hoarding Disorder (HD) is a condition marked by difficulty discarding possessions, leading to significant functional impairment.
- No FDA-approved treatments currently exist for HD, a disorder often co-occurring with Major Depressive Disorder (MDD).
Purpose of the Study:
- To assess the feasibility and initial effectiveness of repetitive transcranial magnetic stimulation (rTMS) in patients with both HD and MDD.
- To explore rTMS as a potential novel treatment for this complex patient population.
Main Methods:
- Eleven participants with moderate-to-severe MDD and comorbid HD received 20 sessions of neuronavigated intermittent theta burst stimulation (iTBS) rTMS over four weeks.
- Assessments included symptom severity (depression and hoarding) and neuropsychological testing, conducted pre-treatment, post-treatment, and at one-month follow-up.
Main Results:
- A 43% reduction in depression symptoms and a 28% reduction in hoarding symptoms were observed post-treatment, with sustained improvements at follow-up.
- Significant improvements were noted in attention, working memory, visual scanning, processing speed, and verbal learning (p < 0.05).
Conclusions:
- This trial is the first to demonstrate the preliminary feasibility and clinical benefits of rTMS for individuals with MDD and comorbid HD.
- rTMS may represent a new therapeutic avenue for treating this severe and often undertreated disorder, addressing both depression and hoarding symptoms.
Background:
Hoarding Disorder (HD) is characterized by persistent difficulty discarding possessions due to a strong urge to save them, resulting in excessive clutter that compromises functioning. Despite the common prevalence and profound consequences of HD, there are no FDA approved treatments. Individuals with HD often have comorbid major depressive disorder (MDD). This study examined the feasibility and initial efficacy of repetitive transcranial magnetic stimulation (rTMS) for HD patients with comorbid MDD.
Methods:
Participants with moderate or severe MDD and co-morbid HD underwent daily neuronavigated intermittent theta burst stimulation (iTBS) rTMS to the left dorsolateral prefrontal cortex for 20 sessions over four weeks. Assessments of symptoms and neuropsychological performance were collected at pre-treatment, post-treatment, and 1-month follow up.
Results:
Eleven individuals enrolled in the study (6 women; mean age 52). One participant dropped out after six sessions. Following iTBS treatment, depression symptoms on the Hamilton Depression Rating Scale-17 were reduced by 43% at post-treatment and 48% at follow-up. Hoarding symptoms on the Hoarding Rating Scale were reduced by 28% at post-treatment and 29% at follow-up, with the greatest reductions in difficulty discarding. Neuropsychological performance improvements were seen in attention/working memory, visual scanning, processing speed, and verbal learning (p < 0.05).
Conclusions:
This is the first clinical trial of rTMS for MDD + HD and demonstrates preliminary feasibility and clinical improvement and the potential role for rTMS in HD treatment. Using rTMS to treat MDD in individuals with HD may open new avenues of care for this severe and undertreated disorder.
