title: Lack of a therapeutic effect of a 2-week sub-threshold transcranial magnetic stimulation course for treatment-resistant depression.
abstract: Stimulation parameters seem to strongly influence the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the management of treatment-resistant depressed patients. The most effective and safest parameters are yet to be defined. Moreover, systematic follow-up data available to document the duration of the therapeutic effects remain sparse. Twenty-one treatment-resistant depressed patients were randomized to either active rTMS (N=12) or to sham (N=9) treatment in a double-blind design. Patients were kept on their medications. Sub-motor-threshold (MT) stimulation (80% MT) was delivered for 10 consecutive work days (20 Hz, 2-s trains, 20 trains). Subjects meeting pre-set criteria for responding were entered into a follow-up phase for up to 5 months. Utilizing the above stimulation parameters, we found no significant difference between groups. Six patients in the active group and one subject in the sham group met criteria for the follow-up phase. The period of time before subjects met criteria for relapse was highly variable ranging from 2 to 20 weeks. Sub-threshold rTMS stimulation for 2 weeks is not significantly superior to sham treatment for treatment-resistant depressed patients. The duration of the therapeutic effects of rTMS delivered to the left prefrontal cortex using the above-described parameters is highly variable.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA. nash.boutros@yale.edu
authors.forename: Nashaat N
authors.initials: NN
authors.lastname: Boutros
authors.forename: Ralitza
authors.initials: R
authors.lastname: Gueorguieva
authors.forename: Ralph E
authors.initials: RE
authors.lastname: Hoffman
authors.forename: Dan A
authors.initials: DA
authors.lastname: Oren
authors.forename: Alan
authors.initials: A
authors.lastname: Feingold
authors.forename: Robert M
authors.initials: RM
authors.lastname: Berman
mesh_terms: D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D004311:Double-Blind Method; D004569:Electroencephalography; D055590:Electromagnetic Phenomena / Q000379:methods*; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D017397:Prefrontal Cortex / Q000503:physiopathology; D013997:Time Factors; D017211:Treatment Failure