title: Repetitive transcranial magnetic stimulation versus electroconvulsive therapy for the treatment of major depressive disorder, a randomized controlled clinical trial.
abstract: BACKGROUND
  Studies comparing the antidepressant effects of electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have reported mixed results. This study compared the efficacy of rTMS and ECT in adult patients with refractory major depressive disorder (MDD).
  
  
  METHODS
  This randomized, ECT-controlled, parallel-group clinical trial analyzed the antidepressant effects of ECT and rTMS in 73 patients with MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The Beck Depression Inventory and Hamilton Depression Rating Scale were used to measure depression.
  
  
  RESULTS
  Both ECT and rTMS significantly improved depression and suicidal behavior scores. However, ECT reduced depression and suicidal behavior scores more than rTMS. There were no significant adverse effects in the rTMS group.
  
  
  CONCLUSIONS
  Both ECT and rTMS improved MDD in the short term, but the antidepressant efficacy of ECT was greater than rTMS. Moreover, ECT led to greater reductions in suicidal behavior than rTMS. Until strong evidence for the safety and efficacy of rTMS is available, further studies are needed to compare ECT and rTMS in terms of the long-term relapse rate and quality of life.
authors.affiliation: Department of Psychiatry, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran.
authors.forename: Mitra
authors.initials: M
authors.lastname: Keshtkar
authors.forename: Ahmad
authors.initials: A
authors.lastname: Ghanizadeh
authors.forename: Ali
authors.initials: A
authors.lastname: Firoozabadi
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D050781:Transcranial Magnetic Stimulation; D000092864:Suicide Prevention