title: A sham-controlled trial of the efficacy and safety of twice-daily rTMS in major depression.
abstract: BACKGROUND
  Studies of repetitive transcranial magnetic stimulation (rTMS) in depression have mostly involved once-daily treatment, with positive but modest clinical results. This study tested the efficacy and safety of twice-daily rTMS over 2 weeks.
  
  
  METHODS
  Thirty-eight depressed subjects enrolled in a double-blind, sham-controlled trial of twice-daily rTMS (left prefrontal cortex, 10 Hz, 110% intensity, 1500 stimuli per session) over 2 weeks. Mood and neuropsychological functioning were assessed weekly by blind raters, using the Montgomery-Asberg Depression Rating Scale (MADRS) as the primary outcome measure, plus the Hamilton Rating Scale for Depression (HRSD) and self-report measures. After the blind period, 22 subjects continued with once-daily rTMS to receive a total of 6 weeks of active rTMS.
  
  
  RESULTS
  Subjects were moderately treatment resistant. Active treatment resulted in significantly greater improvement than sham over the 2-week blind period on one outcome measure only (MADRS p<0.05). Subjects showed further improvement over the 6 weeks of active rTMS. Neuropsychological test scores did not change significantly.
  
  
  CONCLUSIONS
  rTMS given twice daily was effective and safe, with no adverse neuropsychological effects.
authors.affiliation: School of Psychiatry, University of NSW and Black Dog Institute, Sydney, Australia. colleen.loo@unsw.edu.au
authors.forename: Colleen K
authors.initials: CK
authors.lastname: Loo
authors.forename: Philip B
authors.initials: PB
authors.lastname: Mitchell
authors.forename: Tara F
authors.initials: TF
authors.lastname: McFarquhar
authors.forename: Gin S
authors.initials: GS
authors.lastname: Malhi
authors.forename: Perminder S
authors.initials: PS
authors.lastname: Sachdev
mesh_terms: D000328:Adult; D000339:Affect; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010555:Personality Inventory; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents