Evidence for NIBS in post-stroke and Vascular depression

Abstract Background: Cerebrovascular disease (CVA) increases the risk for depression both acutely and chronically. Repetitive Transcranial Magnetic Stimulation (rTMS) has been FDA approved as a treatment of major depressive disorder after successful clinical trials in patients without stroke. There is evidence for clinical efficacy of medications and psychotherapies to treat depression co-morbid with CVA thought the evidence is based on small clinical trials. Objective: In this study we aimed to clarify the current evidence for the safety and efficacy of rTMS in MDD co-morbid with acute CVA (post-stroke depression) and chronic CVA (vascular depression) Methodology: We conducted a systematic review on the evidence for short-term efficacy of rTMS in MDD co-morbid with CVA (post acute stroke and vascular depression). Randomized controlled and observation trials were included in the review based on pre-set criteria. Quality of the evidence was evaluated using standardized scales. Results: A total of 5 trials were included (3 randomized controlled and 2 observational). 146 patients with MDD comorbid with chronic CVA (=vascular depression) and 40 patients with MDD post acute stroke (-post stroke depression) treated with rTMS were included in the review. Evidence suggests preliminary efficacy and general safety of rTMS in this population. Discussion: Despite evidence of preliminary efficacy and safety of rTMS in post stroke depression and vascular depression, no firm conclusions can be reached at this point due to to small size and heterogeneity of studies available in the literature. Conclusion: Larger, well-designed studies are needed to confirm efficacy and safety of rTMS and other modalities of NIBS in MDD co-morbid with acute and chronic CVA. Further clarification of these findings and their significance will be discussed in this presentation. Keywords: Post stroke depression, vascular depression, rTMS, Systematic Review