title: A randomized, controlled trial of sequential bilateral repetitive transcranial magnetic stimulation for treatment-resistant depression.
abstract: OBJECTIVE
  High-frequency left-side repetitive transcranial magnetic stimulation (rTMS) and low-frequency stimulation to the right prefrontal cortex have both been shown to have antidepressant effects, but doubts remain about the magnitude of previously demonstrated treatment effects. The authors evaluated sequentially combined high-frequency left-side rTMS and low-frequency rTMS to the right prefrontal cortex for treatment-resistant depression.
  
  
  METHODS
  The authors conducted a 6-week double-blind, randomized, sham-controlled trial in 50 patients with treatment-resistant depression. Three trains of low-frequency rTMS to the right prefrontal cortex of 140 seconds' duration at 1 Hz were applied daily, followed immediately by 15 trains of 5 seconds' duration of high-frequency left-side rTMS at 10 Hz. Sham stimulation was applied with the coil angled at 45 degrees from the scalp, resting on the side of one wing of the coil. The primary outcome variable was the score on the Montgomery-Asberg Depression Rating Scale.
  
  
  RESULTS
  There was a significantly greater response to active than sham stimulation at 2 weeks and across the full duration of the study. A significant proportion of the study group receiving active treatment met response (11 of 25 [44%]) or remission (nine of 25 [36%]) criteria by study end compared to the sham stimulation group (two of 25 [8%] and none of 25 respectively).
  
  
  CONCLUSIONS
  Sequentially applying both high-frequency left-side rTMS and low-frequency rTMS to the right prefrontal cortex, has substantial treatment efficacy in patients with treatment-resistant major depression. The treatment response accumulates to a clinically meaningful level over 4 to 6 weeks of active treatment.
authors.affiliation: Alfred Psychiatry Research Centre, the Alfred and Monash University Department of Psychological Medicine, Melbourne, Victoria, Australia. paul.fitzgerald@med.monash.edu.au
authors.forename: Paul B
authors.initials: PB
authors.lastname: Fitzgerald
authors.forename: Jessica
authors.initials: J
authors.lastname: Benitez
authors.forename: Anthony
authors.initials: A
authors.lastname: de Castella
authors.forename: Z Jeff
authors.initials: ZJ
authors.lastname: Daskalakis
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Brown
authors.forename: Jayashri
authors.initials: J
authors.lastname: Kulkarni
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D017397:Prefrontal Cortex / Q000502:physiology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D010919:Placebos