Abstract WP195: Accelerated Repetitive Transcranial Magnetic Stimulation (rTMS) as a Treatment for Subacute Post-Stroke Depression (PSD)

Introduction: Depression affects more than 50% of stroke survivors, reducing quality of life and increasing adverse outcomes. As stroke survivorship improves, the need for innovative treatments for associated stroke morbidity such as PSD is even more urgent. Alternative therapies are necessary due to the limited efficacy of antidepressants and counseling. rTMS is well established as an effective treatment for Major Depressive Disorder (MDD) and some small trials have shown that rTMS may be effective for chronic PSD; however, no trials have looked at an accelerated rTMS protocol in the subacute stroke period for PSD. Hypothesis: An accelerated rTMS protocol will be a safe and feasible option to effectively reduce PSD symptoms within 6 months of ischemic stroke onset. Methods: Patients (N = 6) with radiographic evidence of ischemic stroke within the last 2 weeks to 6 months who had Hamilton Depression Rating Scale (HAMD-17) scores ≥ 8 were recruited for an open label study using an accelerated rTMS protocol as follows: High frequency (20 Hz) rTMS at 110% resting motor threshold (RMT) was applied to the left dorsolateral prefrontal cortex (DLPFC) during 5 sessions per day over 4 consecutive days for a total of 20 sessions. Forty trains of 2 second duration were applied with a 12 second intertrain interval for a total of 1560 pulses per session. Before and after the 4-day neurostimulation protocol, outcome measures were obtained for the HAMD, modified Rankin Scale (mRS), functional independence measures (FIM), and National Institutes of Health Stroke Scales (NIHSS). These same measures were obtained at 3-month follow up. Results: HAMD significantly decreased (Wilcoxon p = 0.03) from M=15.5 (2.81) to 4.17 (0.98) following rTMS, a difference which persisted to the 3-month follow-up (p=0.03). No statistically significant difference in FIM, mRS, or NIHSS were observed. No significant adverse events related to the treatment were observed. Conclusions: Our preliminary results indicate that an accelerated rTMS protocol is safe and feasible, and may be an effective alternative or adjunctive therapy for patients suffering from PSD. Future planned studies include a larger, randomized controlled trial in this population.