title: Efficacy of high-frequency repetitive transcranial magnetic stimulation in treatment-resistant depression.
abstract: We examined the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) in 419 patients with treatment-resistant depression. The patients received daily sessions of rTMS over the left prefrontal cortex as an adjuvant to pharmacotherapy. The rTMS intensity was set at 100% of the motor threshold and 25 Hz stimulation, with train duration of 2 seconds delivered at 30-second intervals. A full course comprised 1000 magnetic pulses. Depression was rated using the Hamilton Depression Rating Scale (HAMD) before and after treatment. Response was defined as a 50% reduction in the HAMD score. Patients with HAMD scores of less than 8 were considered to be in remission. The mean HAMD score for the study group decreased from 22.59 ± 5.92 to 10.50 ± 5.83 (P < .001). After the treatment period, 268 (64%) out of 419 patients demonstrated significant mood improvements, as indexed by a reduction of more than 50% on the HAMD score. In addition, 140 patients (33.4%) attained remission (HAMD score <8); and 11 patients achieved a partial response. Treatment was generally well tolerated, and no serious adverse effects were reported. In conclusion, high-frequency (25 Hz) rTMS was well tolerated and found to be statistically and clinically effective in patients with treatment-resistant depression. This study contributed to the existing evidence of the antidepressant effect of rTMS in the treatment of depression.
authors.affiliation: Department of Psychiatry, NPISTANBUL Neuropsychiatry Hospital, Istanbul, Turkey.
authors.forename: Nevzat
authors.initials: N
authors.lastname: Tarhan
authors.forename: F Gökben Hizli
authors.initials: FG
authors.lastname: Sayar
authors.forename: Oguz
authors.initials: O
authors.lastname: Tan
authors.forename: Gaye
authors.initials: G
authors.lastname: Kagan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000503:physiopathology* / Q000628:therapy*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology; D017397:Prefrontal Cortex / Q000502:physiology*; D011247:Pregnancy; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult