Neurocognitive effects of repetitive transcranial magnetic stimulation in severe major depression.
OBJECTIVE
Repetitive transcranial magnetic stimulation (rTMS) is being investigated as a potential treatment for depression. Few studies have addressed the neurocognitive effects of a course of rTMS in severely depressed patients. We evaluated neurocognitive effects of a 1-4 week course (mean 3 weeks) of rTMS using an aggressive set of parameters, in 15 severely depressed subjects.


METHODS
A battery of neurocognitive tests relevant to attention, working memory-executive function, objective memory and motor speed were administered to 15 subjects with treatment-resistant major depression (unipolar and bipolar), before and after a course of rTMS. Mean z scores were computed for each of 4 cognitive domains and analyzed using repeated measures multivariate analysis of covariance. Significant interactions were further clarified using univariate analysis of variance.


RESULTS
There was no worsening of performance on any of the cognitive domains over the baseline-post rTMS period. On the contrary, evidence of modest but statistically significant improvement in performance was noted in working memory-executive function, objective memory and fine motor speed domains over the rTMS treatment period.


CONCLUSIONS
There was no evidence of adverse neurocognitive changes over the baseline-post rTMS period in 15 treatment-resistant depressed subjects undergoing a 3 week (mean) trial of rTMS. Significant improvements in several domains observed over the rTMS treatment period could not be explained by improved mood. Practice effects as well as other factors potentially contributing to these findings are discussed.


CONCLUSIONS
rTMS is being increasingly studied as a neurophysiological probe as well as for its potential antidepressive effects. The effects on neuronal function raise appropriate questions of safety of its use at varying stimulus parameters and durations. This study contributes to the small body of evidence of the cognitive effects of rTMS in severely depressed patients.
Martis
Brian
B
Department of Psychiatry, Psychiatric Clinical Research Center and Center for Cognitive Medicine, University of Illinois at Chicago, 912 South Wood Street Suite 137 MC 913, Chicago, IL 60612, USA. bmartis@psych.uic.edu
Alam
Danesh
D
Dowd
Sheila M
SM
Hill
S Kristian
SK
Sharma
Rajiv P
RP
Rosen
Cherise
C
Pliskin
Neil
N
Martin
Eileen
E
Carson
Valorie
V
Janicak
Philip G
PG
D000328:Adult; D001288:Attention; D003072:Cognition Disorders / Q000628:therapy*; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D004558:Electric Stimulation / Q000379:methods*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D009043:Motor Activity; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance; D011930:Reaction Time; D050781:Transcranial Magnetic Stimulation