rTMS-BDD

Information

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuromodulating therapy, in which magnetic pulses given to cortical regions lead to changes in brain circuits involved in psychiatric disorders. rTMS is an emerging, evidence based and safe treatment option for major depressive disorder (MDD). Response rates for depression are estimated between 28 to 83%, depending on the protocol, cortical location, refractoriness or combined therapy. Furthermore there is current evidence that rTMS is an effective intervention in obsessive-compulsive disorder.

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A recent case series, by our research group, showed that when combining rTMS with medication and cognitive behavioural therapy (CBT), this has an additive effect on reducing depressive as well as body dysmorphic symptoms.

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In individuals with body dysmorphic disorder (BDD) there is a preoccupation with non-existent or minor imperfections in their appearance. Obsessive thoughts, repetitive compulsions, regularly checking or seeking for reassurance, could completely control the life of these individuals. This mental disorder is frequently associated with disturbing psychosocial impairment, depressive and anxiety comorbidity and even suicidality. Current evidence-based treatment options are psychotherapy (CBT) or antidepressant medication as SSRI’s. In 60-70% treatment is effective. Nevertheless, there are opportunities for improvement in BDD treatment and neuromodulation is very scarce. We therefore set up a randomized controlled trial (RCT) in BDD patients focusing on the clinical effect of rTMS on BDD symptoms. Our secondary objective is to analyse the effect on other psychiatric symptoms, such as depression and anxiety. We also look at the quality of life. In total 40-56 patients with BDD, aged 18-65, will be included and divided into two groups. One group receives regular rTMS treatment, the other group receives sham rTMS (control). Patients in both groups undergo 15 rTMS or sham rTMS sessions, once a day, 5 days/week, for 3 weeks. Results are measured using several questionnaires, BDD-YBOCS, BABS, Sheehan, CGI, HDRS and HAS, every 5th rTMS session or sham rTMS session.

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Researcher:

Dr. K.W.F. Scheepstra, psychiatrist Amsterdam UMC, loc. AMC

Dr. N.C.C. Vulink, psychiatrist Amsterdam UMC, loc. AMC

M.C. Ploegaert, MSc, rTMS technician Amsterdam UMC, loc. AMC

D. Neuteboom, MD, researcher Amsterdam UMC, loc. AMC

M.W. van Paridon, psychiatrist Amsterdam UMC, loc. AMC