Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial.
BACKGROUND
High-frequency left-sided repetitive transcranial magnetic stimulation (HFL-TMS) has been shown to have antidepressant effects in double-blind trials. Low-frequency stimulation to the right prefrontal cortex (LFR-TMS) has also shown promise, although it has not been assessed in treatment-resistant depression and its effects have not been compared with those of HFL-TMS.


OBJECTIVE
To prospectively evaluate the efficacy of HFL-TMS and LFR-TMS in treatment-resistant depression and compared with a sham-treated control group.


METHODS
A double-blind, randomized, sham-controlled trial.


METHODS
Two general psychiatric services.


METHODS
Sixty patients with treatment-resistant depression who had failed to respond to therapy with multiple antidepressant medications were divided into 3 groups of 20 that did not differ in age, sex, or any clinical variables. All patients completed the double-blind phase of the study.


METHODS
Twenty 5-second HFL-TMS trains at 10 Hz and five 60-second LFR-TMS trains at 1 Hz were applied daily. Sham stimulation was applied with the coil angled at 45 degrees from the scalp, resting on the side of one wing of the coil. Main Outcome Measure Score on the Montgomery-Asberg Depression Rating Scale.


RESULTS
There was a significant difference in response among the 3 groups (F56,2 = 6.2), with a significant difference between the HFL-TMS and sham groups and between the LFR-TMS and sham groups (P<.005 for all) but not between the 2 treatment groups. Baseline psychomotor agitation predicted successful response to treatment.


CONCLUSIONS
Both HFL-TMS and LFR-TMS have treatment efficacy in patients with medication-resistant major depression. Treatment for at least 4 weeks is necessary for clinically meaningful benefits to be achieved. Treatment with LFR-TMS may prove to be an appropriate initial repetitive TMS strategy in depression taking into account safety, tolerability, and efficacy considerations.
Fitzgerald
Paul B
PB
Alfred Psychiatry Research Centre, The Alfred Hospital, and the Department of Psychological Medicine, Monash University, Australia. paul.fitzgerald@med.monash.edu.au
Brown
Timothy L
TL
Marston
Natasha A U
NA
Daskalakis
Z Jeff
ZJ
De Castella
Anthony
A
Kulkarni
Jayashri
J
D000328:Adult; D001921:Brain / Q000502:physiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D017397:Prefrontal Cortex / Q000502:physiology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D010919:Placebos