title: Repetitive transcranial magnetic stimulation (rTMS) in major depression: relation between efficacy and stimulation intensity.
abstract: Repetitive transcranial magnetic stimulation (rTMS) has been found to exert modest to substantial antidepressant effects in the majority of prior clinical studies. As effect sizes and stimulation conditions have varied greatly, controversy persists regarding effective stimulation parameters (e.g. intensity, frequency, localization). In the present controlled study, we investigated whether the antidepressant efficacy of rTMS may be related to the stimulation intensity applied. Thirty-one patients suffering from a pharmacotherapy-resistant major depressive episode were randomly assigned to three treatment groups receiving rTMS at different stimulation intensities: (1) intensity at the individual motor threshold (MT); (2) 90% subthreshold intensity; and (3) low intensity of standard sham rTMS. Each patient underwent 10 sessions of 10 Hz rTMS with 1500 stimuli/day over the left dorsolateral prefrontal cortex. Improvement of depressive symptoms after rTMS significantly increased with stimulation intensity across the three groups. A 30% to 33% reduction of baseline depression scores was observed after rTMS at MT intensity. Similarly, groups differed significantly regarding the clinical course after rTMS with the lowest number of antidepressant interventions and the shortest hospital stay in the MT intensity group. These findings support the hypothesis of a relationship between stimulation intensity of rTMS and its antidepressant efficacy.
authors.affiliation: Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany. padberg@nk-i.med.uni-muenchen
authors.forename: Frank
authors.initials: F
authors.lastname: Padberg
authors.forename: Peter
authors.initials: P
authors.lastname: Zwanzger
authors.forename: Martin E
authors.initials: ME
authors.lastname: Keck
authors.forename: Norbert
authors.initials: N
authors.lastname: Kathmann
authors.forename: Patrick
authors.initials: P
authors.lastname: Mikhaiel
authors.forename: Robin
authors.initials: R
authors.lastname: Ella
authors.forename: Philipp
authors.initials: P
authors.lastname: Rupprecht
authors.forename: Heike
authors.initials: H
authors.lastname: Thoma
authors.forename: Harald
authors.initials: H
authors.lastname: Hampel
authors.forename: Nicola
authors.initials: N
authors.lastname: Toschi
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Möller
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology; D001931:Brain Mapping; D003865:Major Depressive Disorder / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006261:Headache / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D050781:Transcranial Magnetic Stimulation
chemical_list: D000928:Antidepressive Agents