The use of repetitive transcranial magnetic stimulation and vagal nerve stimulation in the treatment of depression.
OBJECTIVE
Patients with depressive disorders often fail to respond to standard antidepressant medications and have few available treatment alternatives. Repetitive transcranial magnetic stimulation and vagal nerve stimulation have been developed and investigated over the last 10 years as potential treatment options for this and other psychiatric conditions. The aim of this paper is to review recent therapeutic trials of these techniques.


RESULTS
Recent studies appear to have confirmed that standard left-sided repetitive transcranial magnetic stimulation has antidepressant efficacy, but that the degree of clinical effect may be somewhat limited. Promising data are emerging suggesting that other approaches, including right unilateral repetitive transcranial magnetic stimulation and sequential bilateral stimulation, may have equal or potentially greater effects. The evidence for the effectiveness of vagal nerve stimulation remains restricted to the primary company-sponsored trials. Although limited, these data suggest that valuable treatment effects may develop over time.


CONCLUSIONS
Further repetitive transcranial magnetic stimulation research should actively investigate novel stimulation approaches before high-frequency left-sided stimulation is accepted as the standard approach. Given the invasive nature of vagal nerve stimulation and potential side effects, further research is urgently required. This should include the development of predictors of clinical response and definition of stimulation parameters with enhanced efficacy.
Fitzgerald
Paul B
PB
The Alfred and Monash University School of Psychology, Psychiatry and Psychological Medicine, Victoria, Australia. paul.fitzgerald@med.monash.edu.au
Daskalakis
Zafiris J
ZJ
D000339:Affect / Q000502:physiology; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004292:Dominance, Cerebral / Q000502:physiology; D004599:Electric Stimulation Therapy; D004565:Electroconvulsive Therapy; D006801:Humans; D017397:Prefrontal Cortex / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*