NIJMEGEN, The Netherlands, November 17, 2017 —
Transcranial magnetic stimulation (rTMS) combined with concurrent psychotherapy seems more effective, then either alone, as will be 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 a lasting benefit after 6 months for the majority of patients in this group.
Psychotherapy combined with rTMS provides a safe and durable treatment for depression
A large study by Donse, Padberg, Sack, Rush and Arns , carried out in the Netherlands has investigated the effects of combining brain stimulation (rTMS) with concurrent psychotherapy in treatment resistant depression. The results of this study suggest that a combined approach is more clinically effective than if either therapy was delivered alone and can be delivered safely. 66% of the patients in this study responded positively to the combined therapy (i.e. symptom decrease of more than 50%), while 56% of the total sample achieved remission (meaning that they no longer met criteria for depression). Follow-up after 6 months demonstrated that the majority of patients still had reduction of symptoms from the initial course of treatment, which suggests that the effects are durable which is consistent with previous studies for these techniques when studied as a monotherapy. The results of this study will be published this month in the leading international journal: Brain Stimulation.
This study's robust 56% remission rate compares favorably to studies when either rTMS or Psychotherapy are conducted as a monotherapy suggesting there may be additional benefit in combining therapies in what is a more complicated patient population to treat. Similarly, psychotherapy and antidepressant medications combined have been shown to provide better outcomes than either used as a monotherapy in some patient groups.
The efficacy of rTMS as a monotherapy (i.e. conducted without individual psychotherapeutic support) is recognized throughout the world as a valid treatment for Depression and is furthermore supported by FDA approval in the United States, and is recognized by NICE in the United Kingdom. Since 2011, Health Insurance providers in The United States, and more recently, in The Netherlands, reimburse rTMS treatment for treatment resistant depression.
How might this combined treatment work?
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, whereby indirectly stimulation of the sgACC is also achieved transsynaptically as demonstrated before using NCG-TMS . For psychotherapy, it is thought that among other areas, it also activates the deeper sgACC in this network more directly. Concurrent application of both techniques could activate a larger part of this malfunctioning 'depression network', with higher clinical efficacy.
About neuroCare Group
neuroCare offers specialized and integrated treatments with personalized solutions for ADHD, insomnia, depression and OCD. In these areas neuroCare only employs state-of-the-art and evidence based techniques, integrated and embedded in a clinical-psychological setting. Personalized neurofeedback is used in the treatment of ADHD, and brain stimulation (rTMS) for the treatment of depression using only evidence based protocols. neuroCare has worldwide clinics in multiple locations throughout the US, Australia, Germany and the Netherlands.
References:  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
 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
SOURCE neuroCare Group