title: Repetitive transcranial magnetic stimulation in combination with citalopram in young patients with first-episode major depressive disorder: a double-blind, randomized, sham-controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) started with citalopram in first-episode young major depressive patients.
  
  
  METHODS
  In a 2-week double-blind study with a 2-week extended antidepressant phase, 60 first-episode young major depressive patients were randomly assigned to citalopram in combination with 2 weeks of either active or sham rTMS treatment. During the following 2 weeks, the patients continued only the citalopram treatment. The 17-item Hamilton depression rating scale (HAMD-17) and Montgomery-Asberg depression rating scale (MADRS) were used to assess the severity of depression. Moreover, the Wisconsin Card Sorting Test (WCST), Trail-Making Test (TMT), and Stroop Color-Word Test (SCWT) were used to assess executive function.
  
  
  RESULTS
  (1) There was a significantly greater number of early improvers (a reduction of HAMD-17 score ≥ 20% within the first 2 weeks) observed in the active rTMS group compared to the sham group (57% vs. 29%, χ(2)=4.667, p=0.031). (2) There was no significant difference observed in responder rates (46% vs. 36%, χ(2)=0.295, p=0.586) or in remission rates (39% vs. 29%, χ(2)=0.319, p=0.572) between the two groups at 4 weeks. (3) There was a significant difference seen in both HAMD-17 and MADRS scores between the two groups at 2 and 4 weeks. The active rTMS group showed a significantly faster score reduction compared to the sham group at 2 weeks (HAMD-17, t=13.444, p=0.001; MADRS, t=30.123, p=0.000), which was maintained at 4 weeks on both scales (HAMD-17, t=46.915, p=0.000; MADRS, t=39.996, p=0.000). (4) The patients did not deteriorate in executive performance, and even improved in categories on WCST and completed TMT faster in the active group.
  
  
  CONCLUSIONS
  RTMS accelerated the rapidity of the antidepressant response in first-episode young depressive patients. Our results call for future rTMS studies with larger sample sizes, high intensity of stimuli, and longer duration to draw more definitive conclusions.
authors.affiliation: Department of Mental Health, First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China.
authors.forename: Man-li
authors.initials: ML
authors.lastname: Huang
authors.forename: Ben-yan
authors.initials: BY
authors.lastname: Luo
authors.forename: Jian-bo
authors.initials: JB
authors.lastname: Hu
authors.forename: Shan-Shan
authors.initials: SS
authors.lastname: Wang
authors.forename: Wei-hua
authors.initials: WH
authors.lastname: Zhou
authors.forename: Ning
authors.initials: N
authors.lastname: Wei
authors.forename: Shao-hua
authors.initials: SH
authors.lastname: Hu
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015283:Citalopram / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D042241:Early Diagnosis; D061345:Early Medical Intervention / Q000379:methods*; D056344:Executive Function / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D050781:Transcranial Magnetic Stimulation / Q000379:methods / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram