Sequential Multilocus Repetitive Transcranial Magnetic Stimulation for Treatment of Tinnitus With and Without Comorbid Major Depressive Disorder

Zoe R Berman; Cole Citrenbaum; Juliana Corlier; Andrew F Leuchter; Robert L Folmer; Michael K Leuchter

doi:10.1016/j.neurom.2024.01.001

Sequential Multilocus Repetitive Transcranial Magnetic Stimulation for Treatment of Tinnitus With and Without Comorbid Major Depressive Disorder

Neuromodulation. 2024 Jun;27(4):774-780. doi: 10.1016/j.neurom.2024.01.001. Epub 2024 Feb 21.

Authors

Zoe R Berman¹, Cole Citrenbaum², Juliana Corlier², Andrew F Leuchter², Robert L Folmer³, Michael K Leuchter⁴

Affiliations

¹ TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at University of California Los Angeles, Los Angeles, CA, USA; McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, TX, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
² TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
³ Department of Otolaryngology, Oregon Health & Science University, Portland, OR, USA; National Center for Rehabilitative Auditory Research, VA Portland Medical Center, Portland, OR, USA.
⁴ TMS Clinical and Research Program, Neuromodulation Division, Semel Institute for Neuroscience and Human Behavior at University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA. Electronic address: mkleuchter@mednet.ucla.edu.

PMID: 38385935
DOI: 10.1016/j.neurom.2024.01.001

Abstract

Objective: Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment for tinnitus, although outcomes are highly variable. We previously described a multilocus sequential rTMS treatment protocol for tinnitus involving stimulation of both prefrontal and auditory targets. In this study, we report results using this approach in an open-label treatment study of tinnitus with and without comorbid major depressive disorder (MDD).

Materials and methods: Forty patients with chronic tinnitus (mean age 56 years, ten female) and with (n = 17) or without (n = 23) MDD received multilocus rTMS administered sequentially to 1) left dorsolateral prefrontal cortex, followed by 2) auditory cortex (Heschel's gyrus). Patients completed weekly self-report ratings using the Tinnitus Functional Index (TFI) and Tinnitus Handicap Inventory, and patients with MDD completed the Inventory of Depressive Symptomatology Self-Report 30-item.

Results: Patients showed significant mean improvement in tinnitus at sessions 5 (mean TFI improvement 6.8 points ± 12.2, p = 0.002) and 10 (mean improvement 9.2 points ± 14.1, p = 0.002), with 48% of patients responding within ten treatment sessions. Responders were significantly older than nonresponders (61.5 ± 15 years vs 51.3 ± 16 years), and there was a trend toward decreased likelihood of response in subjects with comorbid MDD compared with subjects without comorbidity (odds ratio = 0.28, p = 0.06). Patients with comorbid MDD reported significantly less improvement after ten sessions than did those with tinnitus alone (4.3 ± 10.3 vs 14.7 ± 15.0 points, p = 0.04). Post hoc analyses suggested that the comorbid group achieved improvement comparable to that of the tinnitus-only group after 30 treatments.

Conclusions: Patients showed significant improvement in tinnitus from multilocus sequential rTMS treatment, and those with tinnitus alone improved more quickly. Those with depression who continued rTMS through a full 30-session course further improved, indicating that tinnitus with comorbid MDD may respond with extended treatment.

Keywords: Depression; measurement-based care; repetitive transcranial magnetic stimulation (rTMS); tinnitus; tinnitus functional index (TFI).

MeSH terms

Adult
Aged
Depressive Disorder, Major* / complications
Depressive Disorder, Major* / epidemiology
Depressive Disorder, Major* / psychology
Depressive Disorder, Major* / therapy
Female
Humans
Male
Middle Aged
Tinnitus* / epidemiology
Tinnitus* / therapy
Transcranial Magnetic Stimulation* / methods
Treatment Outcome