title: Transcranial magnetic stimulation for the treatment of depression: feasibility and results under naturalistic conditions: a retrospective analysis.
abstract: An increasing number of controlled studies strongly support an antidepressant effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex. However, these data come from highly selected study populations. Whether rTMS is a feasible therapeutic tool for the treatment of depression under naturalistic condition has not yet been addressed. Here, we report results from 232 depressive patients [aged 20-76 years, baseline Hamilton Depression Rating Score (HDRS-21) 24.0 ± 7.3] treated with rTMS add-on to continued psychopharmacological treatment in a naturalistic clinical setting. Two thousand stimuli of 20-Hz rTMS were applied daily over the left dorsolateral prefrontal cortex with an intensity of 110% of motor threshold. Treatment duration was individually planned and varied between 10 and 20 sessions. In average, patients received 13 ± 6.1 rTMS sessions. In 90% of the cases, treatment was terminated regularly. No severe side effects were observed. Only four patients stopped rTMS treatment because of side effects. Ratings with the HDRS-21 before and after treatment were available in 130 patients. The average improvement of the HDRS-21 in this subsample was 9.0 ± 9.2 points. Fifty-three patients had an improvement of 50% or more. These results document that rTMS is feasible, safe and well tolerated under naturalistic conditions.
authors.affiliation: Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Regensburg, Universitätsstraße 84, Regensburg, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Frank
authors.forename: Peter
authors.initials: P
authors.lastname: Eichhammer
authors.forename: Julia
authors.initials: J
authors.lastname: Burger
authors.forename: Marc
authors.initials: M
authors.lastname: Zowe
authors.forename: Michael
authors.initials: M
authors.lastname: Landgrebe
authors.forename: Göran
authors.initials: G
authors.lastname: Hajak
authors.forename: Berthold
authors.initials: B
authors.lastname: Langguth
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult