title: A randomized double-blind sham-controlled comparison of unilateral and bilateral repetitive transcranial magnetic stimulation for treatment-resistant major depression.
abstract: OBJECTIVE
  High frequency left-sided (HFL) and low frequency right-sided (LFR) unilateral repetitive transcranial magnetic stimulation (rTMS) are efficacious in treatment-resistant major depression (TRD). Similar benefit has been suggested for sequential bilateral rTMS (LFR then HFL). There are few published reports on the efficacy of sequential bilateral rTMS compared to HFL and sham rTMS. Therefore, this study evaluated the efficacy of HFL and sequential bilateral rTMS compared to sham in TRD.
  
  
  METHODS
  Subjects between the ages of 18 and 85 were recruited from a tertiary care university hospital. Seventy-four subjects with TRD and a 17-item Hamilton Depression Rating Scale (HDRS) greater than 21 were randomized to receive unilateral, bilateral, or sham rTMS. The rates of remission were compared among the three treatment groups.
  
  
  RESULTS
  The remission rates differed significantly among the three treatment groups using a modified intention to treat analysis that excluded subjects who did not respond to electroconvulsive therapy (ECT) during the current episode. The remission rate was significantly higher in the bilateral group than the sham group. The remission rate in the unilateral group did not differ from either group.
  
  
  CONCLUSIONS
  These findings warrant larger controlled studies that compare the efficacy of sequential bilateral rTMS and HFL rTMS in TRD.
authors: Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors: Daniel M
authors: DM
authors: Blumberger
authors: Benoit H
authors: BH
authors: Mulsant
authors: Paul B
authors: PB
authors: Fitzgerald
authors: Tarek K
authors: TK
authors: Rajji
authors: Arun V
authors: AV
authors: Ravindran
authors: L Trevor
authors: LT
authors: Young
authors: Andrea J
authors: AJ
authors: Levinson
authors: Zafiris J
authors: ZJ
authors: Daskalakis
mesh_terms: D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome