title: Augmenting antidepressants with deep transcranial magnetic stimulation (DTMS) in treatment-resistant major depression.
abstract: OBJECTIVE
  Deep transcranial magnetic stimulation (DTMS) has been shown to be efficacious and relatively safe for major depressive disorder (MDD). However, its clinical utility as an augmenting strategy for treatment-resistant depression (TRD) remains unexplored.
  
  
  METHODS
  In an open label trial, 17 outpatients with severe TRD received 4 weeks of daily high frequency DTMS over the left dorsolateral prefrontal cortex. Depressive and anxious symptoms, suicidality and quality of life (QOL) were measured at baseline (i.e., in the week prior to the start of the DTMS treatment) and at week 5 (i.e., in the week following the end of the DTMS treatment). Primary outcome measures were rates of response and remission at week 5 using an intention-to-treat approach.
  
  
  RESULTS
  Response and remission rates at week 5 were 70.6 and 41.2%, respectively. Also, depression, anxiety, and suicidality ratings were significantly improved by week 5 (with Hedges' g estimates ranging from 0.6 to 1.72), as well as four of the five QOL domain scores (i.e., global, psychological, environmental and social). Finally, two patients dropped out of the study at week 1 because of significant scalp discomfort during stimulation.
  
  
  CONCLUSIONS
  Our study suggests that DTMS, when used as an augmenting strategy for antidepressants in severe TRD, is efficacious, safe and relatively well tolerated. However, controlled studies with larger samples are needed to confirm and expand our preliminary findings.
authors: Depressive Disorders Program, Douglas Mental Health University Institute and McGill University , Montréal, Québec , Canada.
authors: Marcelo T
authors: MT
authors: Berlim
authors: Frederique
authors: F
authors: Van den Eynde
authors: Santiago
authors: S
authors: Tovar-Perdomo
authors: Eduardo
authors: E
authors: Chachamovich
authors: Abraham
authors: A
authors: Zangen
authors: Gustavo
authors: G
authors: Turecki
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001007:Anxiety / Q000628:therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D011788:Quality of Life / Q000523:psychology; D059020:Suicidal Ideation; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: prospective study; quality of life; transcranial magnetic stimulation; treatment-resistant depression; unipolar major depression