KETAMINE THERAPY COMBINED WITH REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS) FOR MAJOR DEPRESSIVE DISORDER AT A SUBURBAN TERTIARY CLINIC

Background: Repetitive transcranial magnetic stimulation (rTMS) is a neurostimulatory technique approved for the treatment of major https://doi.org/10.1016/j.brs.2021.07.023 depressive disorder (MDD) impacting orbital frontal cortex functioning. We have previously identified significant changes in ratings for several standard metrics for depression, anxiety, pain and ADHD after 6 weeks of standard rTMS therapy. Objective/Hypothesis:We examined the effects of rTMS for the treatment of MDD on resilience measured using the Brief Resilience Inventory. Design/Methods: A retrospective review of medical records was carried out on patients with MDD undergoing rTMS therapy at AwakeningsKC Clinical Neuroscience Institute (CNI), a suburban tertiary psychiatric clinic. A detailed de-identified data set of clinical outcomes was compiled. Brief Resilience Scale, Montgomery-Åsberg Depression Rating Scale (MADRS); Patient Health Questionnaire 9 (PHQ-9) total scores were evaluated over 6 weeks of treatment to assess clinical response.

Results: Our survey included 62 participants [N1⁄426 males, N1⁄436 females] with average baseline PHQ-9 scores of 16.3±6, classified as “moderately severe depression”. Baseline BRS scores increased significantly from 2.1±0.86 at baseline to 2.7±0.78 at week 6 (mean 1⁄4 0.46, 95% CI 0.18-0.73, t1⁄43.4, p<0.001). The response was inversely correlated with the change in MADRS (28.6±8 Baseline; 15.5±11 Week 6; r1⁄4 -0.5; p<0.001) and PHQ9 (r1⁄4 -0.42, p<0.01).

Conclusions: rTMS for MDD was associated with a significant increase in resiliency that correlated with mood change after 6 weeks of standard therapy. Conflicts of Interest and Funding Source: Dr. Davila is the owner of AwakeningsKC, Amelia Hess and Ananya are employed by AwakeningsKC. KETAMINE THERAPY COMBINED WITH REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) FOR MAJOR DEPRESSIVE DISORDER AT A SUBURBAN TERTIARY CLINIC Maria Cristina Davila , Amelia Hess , Ananya Louviere , Ann M. Manzardo . AwakeningsKC Clinical Neuroscience Institute Department of Psychiatry & Behavioral Sciences, University of Kansas Medical Center Abstract

Background: Ketamine is a dissociative anesthetic with antidepressant effects at low doses recently approved by the FDA for the treatment of severe depression. This novel application of ketamine has not been studied in combinationwith repetitive transcranial magnetic stimulation (rTMS), a neurostimulatory technique approved for the treatment of major depressive disorder (MDD) impacting orbital frontal cortex functioning. Objective/Hypothesis:We examined outcomes of patients withMDD after combined rTMS and Ketamine therapy to consider safety and effectiveness in an outpatient setting. Design/Methods: A retrospective review of medical records was carried out on patients with MDD undergoing combined Ketamine and rTMS therapy at AwakeningsKC Clinical Neuroscience Institute (CNI), a suburban tertiary psychiatric clinic. A detailed de-identified data set of clinical outcomes was compiled. Patient Health Questionnaire 9 (PHQ-9) and Becks Depression Inventory total scores were evaluated over 6 weeks of treatment to assess clinical response.

Results: Our survey included 29 patients [N1⁄4 17males, N1⁄4 12 females] with average baseline PHQ-9 scores of 17.5±5, classified as “severe depression”. Fifteen patients [N1⁄4 8males, N1⁄4 7 females] have completed 6 weeks of therapy to date. Among these, PHQ9 scores decreased by 8.8±6Background: Ketamine is a dissociative anesthetic with antidepressant effects at low doses recently approved by the FDA for the treatment of severe depression. This novel application of ketamine has not been studied in combinationwith repetitive transcranial magnetic stimulation (rTMS), a neurostimulatory technique approved for the treatment of major depressive disorder (MDD) impacting orbital frontal cortex functioning. Objective/Hypothesis:We examined outcomes of patients withMDD after combined rTMS and Ketamine therapy to consider safety and effectiveness in an outpatient setting. Design/Methods: A retrospective review of medical records was carried out on patients with MDD undergoing combined Ketamine and rTMS therapy at AwakeningsKC Clinical Neuroscience Institute (CNI), a suburban tertiary psychiatric clinic. A detailed de-identified data set of clinical outcomes was compiled. Patient Health Questionnaire 9 (PHQ-9) and Becks Depression Inventory total scores were evaluated over 6 weeks of treatment to assess clinical response.

Results: Our survey included 29 patients [N1⁄4 17males, N1⁄4 12 females] with average baseline PHQ-9 scores of 17.5±5, classified as “severe depression”. Fifteen patients [N1⁄4 8males, N1⁄4 7 females] have completed 6 weeks of therapy to date. Among these, PHQ9 scores decreased by 8.8±6 Abstracts Brain Stimulation 14 (2021) 1404e1417s Brain Stimulation 14 (2021) 1404e1417 points to 9.6±7. Similarly, Becks depression inventory total score decreased from a baseline of 30.3±12 to 18.4±12 at week 6.

Conclusions: Ketamine combinedwith rTMS for MDDwas associatedwith a significant decrease in depression after 6 weeks of standard therapy. Conflicts of Interest and Funding Source: Dr. Davila is the owner of AwakeningsKC, Amelia Hess and Ananya are employed by AwakeningsKC. ASTROCYTE PROTEIN LEVELS CHANGE DEPENDING ON OUTCOME OF TRANSCRANIAL MAGNETIC STIMULATION IN DEPRESSION: NEW STAR OF THE SHOW? Andrew M. Fukuda MD PhD , Lauren E. Hindley , Jee Won Diane Kang , Eric Tirrell , Audrey R. Tyrka MD PhD , Linda L. Carpenter MD . a Butler Hospital TMS Clinic and Neuromodulation Research Facility, 345 Blackstone Boulevard, Providence, RI, 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA; Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, Rhode Island 02906, USA

Background: TMS is effective for depression (MDD) but the therapeutic mechanism is not fully known. Astrocytes likely play a role in depression pathology but have not been explored in TMS.

Methods: Serum was collected from a naturalistic population of 35 patients with MDD before and after TMS. A set of astrocytic protein concentrations were determined via Enzyme-linked Immunosorbent Assay. Inventory of Depressive Symptomatology Self Report (IDS-SR) was used as a measure of depression symptom severity, clinical response, and remission. TMS was delivered at 10 Hz to the left dorsolateral prefrontal cortex daily at 120% maximum intensity relative to their motor threshold for a minimum of 3000 pulses.

Results: There was a correlation between %change IDS-SR and %change Glial Fibrillary Acidic Protein (GFAP) (r1⁄4.561, p<0.05), and Vascular Endothelial Growth Factor (VEGF) (r 1⁄4.358, p<0.05). VEGF increased in remitters (%change +12.30%) but decreased in nonremitters (%change -9.24%, p1⁄40.054). This same pattern was observed between responders (+9.35%) and non-responders (-12.42%, p<0.05). GFAP also increased in responders (+151.18%) and decreased in non-responders (-41.10%) (p<0.05). S100-calcium binding protein B did not correlate with depression severity changes, nor did they differ between those with different clinical outcomes.

Conclusions: Patients with successful TMS outcomes had greater increase in VEGF and GFAP compared to non-responders and a larger increase was associated with greater improvement in depressive symptoms after TMS. This novel pilot data shows promise of astrocytes as important mediators in the mechanism behind TMS’ antidepressant effects. Conflicts of Interest: None to report

Funding: This work was supported by grants from the National Institute of Mental Health (NIMH) R25MH101076 (Dr. AM Fukuda) and P20GM130452 (E Tirrell & Dr. LL Carpenter), and by Butler Internal Funding. RELATIONSHIP OF CHILDHOOD TRAUMA WITH TRANSCRANIAL MAGNETIC STIMULATION OUTCOME FOR DEPRESSION Andrew M. Fukuda MD PhD , Quincy Beck , Eric Tirrell , Audrey R. Tyrka MD PhD , Linda L. Carpenter MD . Butler Hospital TMS Clinic and Neuromodulation Research Facility, 345 Blackstone Boulevard, Providence, RI, 02906, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA; Mood Disorders Research Program and Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, Rhode