Efficacy of transcranial magnetic stimulation (TMS) in depression: naturalistic study.
Transcranial magnetic stimulation (TMS) is a technique is which the evidence has been confirming its efficacy. Repetitive stimulation (rTMS) of the left prefrontal dorsolateral (LPFDL) area with frequencies between 10 and 20 Hz has been shown to be effective in major depression. This article presents the prospective analysis of the treatments performed using TMS on LPFDL at 20 Hz with an intensity of 70% in a protocol of 10 sessions on 107 patients (41 male and 61 female) due to drug treatment resistant depressive symptoms in different conditions. The patients had previously undergone two psychopharmacological attempts with adequate dosage and time, who had been considered candidates for electroconvulsive therapy (ECT) if they did not respond to any conventional treatment. A total of 62.7% had mood disorder, 13.1% obsessive-compulsive disorders (OCT), 7.5% cognitive disorders, 4.7% personality disorders and 3.7% were psychiatric disorders. Mean age of the group was 49.98 years (SD = 17.09). The global results showed that the TMS provided some degree of improvement in 48.6%, although only half, that is 24.3%, maintained it beyond week 12. Efficacy by diagnoses showed a significant difference in favor of affective disorders. In the case of bipolar disorders in the depressive phase, there was improvement in 88.9%, which was maintained in 66.7% of the patients treated. No differences in efficacy were found within each one of the groups diagnosed based on gender, age or presence of personality disorders. The efficacy of the ECT was similar to the TMS in the group in which it had to be applied in comparison with the general group. New studies are proposed with the inclusion of the TMS for resistant-depression treatment protocols in a step prior to the ECT and even before all the drug treatments had been attempted, combining it with them for their potentiation.
Psychiatry Department, Hospital Clínico San Carlos, Madrid. jli@lopezibor.com
Juan José López-Ibor
JJ
Aliño
J L Pastrana
JL
Jiménez
S Cisneros
SC
Flores
M I López-Ibor
MI
Alcocer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult