title: Transcranial magnetic stimulation in the acute treatment of major depressive disorder: clinical response in an open-label extension trial.
abstract: BACKGROUND
  This report describes the results of an open-label extension study of active trans-cranial magnetic stimulation (TMS) in medication-resistant patients with major depressive disorder who did not benefit from an initial course of therapy in a previously reported 6-week, randomized controlled study of active versus sham TMS.
  
  
  METHODS
  Patients with DSM-IV-defined major depressive disorder were actively enrolled in the study from February 2004 through September 2005 and treated with left prefrontal TMS administered 5 times per week at 10 pulses per second, at 120% of motor threshold, for a total of 3000 pulses/session. The primary outcome was the baseline to endpoint change score on the Montgomery-Asberg Depression Rating Scale (MADRS).
  
  
  RESULTS
  In those patients who received sham in the preceding randomized controlled trial (N = 85), the mean reduction in MADRS scores after 6 weeks of open-label active TMS was -17.0 (95% CI = -14.0 to -19.9). Further, at 6 weeks, 36 (42.4%) of these patients achieved response on the MADRS, and 17 patients (20.0%) remitted (MADRS score < 10). For those patients who received and did not respond to active TMS in the preceding randomized controlled trial (N = 73), the mean reduction in MADRS scores was -12.5 (95% CI = -9.7 to -15.4), and response and remission rates were 26.0% and 11.0%, respectively, after 6 weeks of additional open-label TMS treatment.
  
  
  CONCLUSIONS
  This open-label study provides further evidence that TMS is a safe and effective treatment of major depressive disorder. Furthermore, continued active TMS provided additional benefit to some patients who failed to respond to 4 weeks of treatment, suggesting that longer courses of treatment may confer additional therapeutic benefit.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00104611.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle, WA 98104-2499, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Avery
authors.forename: Keith E
authors.initials: KE
authors.lastname: Isenberg
authors.forename: Shirlene M
authors.initials: SM
authors.lastname: Sampson
authors.forename: Philip G
authors.initials: PG
authors.lastname: Janicak
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Lisanby
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Maixner
authors.forename: Colleen
authors.initials: C
authors.lastname: Loo
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Mark A
authors.initials: MA
authors.lastname: Demitrack
authors.forename: Mark S
authors.initials: MS
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012074:Remission Induction; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome