Treating Depression in Multiple Sclerosis with Transcranial Magnetic Stimulation: A Pilot Study

Depression is two to three times more common in people with multiple sclerosis (pwMS) than the general population.

To evaluate the efficacy and tolerability of intermittent theta burst stimulation (iTBS) in treating depressive symptoms in pwMS and major depressive disorder (MDD).

Twenty-one pwMS and MDD participated in an open-label 4-week trial of iTBS to the left dorsolateral prefrontal cortex (L-DLPFC). The Hamilton Depression Rating Scale (HAMD-17), California Verbal Learning Test Second Edition Total Learning (CVLT-II-TL), Brief Visuospatial Memory Test - Revised Total Learning (BVMT-R-TL) and Symbol Digit Modalities Test (SDMT) were administered before and after treatment. The primary outcome was response rates on HAMD-17, defined as a >50% reduction from baseline.

Depression scores decreased from baseline to post-treatment with a mean reduction of 10.24 points (d = 1.55, 95% CI 0.83 to 2.25, P < .001). Ten (58.8%) pwMS responded to treatment, and seven (41.2%) were non-responders (n = 17). The treatment response group showed lower depression scores post-treatment than non-responders (d = -3.01, 95% CI -4.43 to -1.55, P < .001). Post-treatment, responders showed higher visuospatial memory (d = 1.11, 95% CI 0.06 to 2.14, P = .039) and information processing scores (d = 1.74, 95% CI 0.58 to 2.87, P = .003) compared to non-responders. There were two drop-outs, and two participants were lost to follow-up. There were no serious adverse events.

iTBS can improve depressive symptoms in pwMS and MDD and may be associated with cognitive improvement.

NCT04621708.