title: Comparison of repetitive transcranial magnetic stimulation and electroconvulsive therapy in unipolar non-psychotic refractory depression: a randomized, single-blind study.
abstract: Repetitive transcranial magnetic stimulation (rTMS) can induce significant antidepressant effects and, for some patients, might be an alternative to electroconvulsive therapy (ECT). The results of studies comparing the efficacy of rTMS and ECT are mixed and, therefore, comparison of these two therapies needs to be further explored. Forty-two patients aged between 18 and 65 yr, referred to ECT due to unipolar non-psychotic depression refractoriness entered the trial. They were randomly assigned to receive either rTMS or ECT. Depressive symptom changes were blindly measured by Hamilton Depression Rating Scale, Visual Analogue Scale and Clinical Global Impression at baseline, after 2 wk and after 4 wk of treatment. There was no difference in the antidepressant efficacy of ECT and rTMS. Response rates were relatively low in both groups (40% and 50% respectively), with no significant difference between them (p=0.55). Remission rates were also low for both groups (20% and 10% respectively), also with no significant difference (p=0.631). There was no significant difference in the neuropsychological test performance after either one of these therapies. Both treatments were associated with a degree of improvement in refractory depression and therefore add to the literature that rTMS can be an effective option to ECT as it is a less costly treatment and is not associated with anaesthetic and other ECT risks.
authors.affiliation: Institute of Psychiatry, University of Sao Paulo, Sao Paulo-SP, Brazil. moarosa@hcnet.usp.br
authors.forename: Moacyr Alexandro
authors.initials: MA
authors.lastname: Rosa
authors.forename: Wagner Farid
authors.initials: WF
authors.lastname: Gattaz
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual-Leone
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Marina Odebrecht
authors.initials: MO
authors.lastname: Rosa
authors.forename: Demetrio Ortega
authors.initials: DO
authors.lastname: Rumi
authors.forename: Martin
authors.initials: M
authors.lastname: Myczkowski
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Silva
authors.forename: Carlos
authors.initials: C
authors.lastname: Mansur
authors.forename: Sergio Paulo
authors.initials: SP
authors.lastname: Rigonatti
authors.forename: Manuel
authors.initials: M
authors.lastname: Jacobsen Teixeira
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Marcolin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003071:Cognition / Q000502:physiology; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012306:Risk; D016037:Single-Blind Method; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome