title: Efficacy, Safety and Tolerability of Augmentative rTMS in Treatment of Major Depressive Disorder (MDD): A Prospective Cohort Study in Croatia.
abstract: BACKGROUND
  An increasing body of research suggest that repetitive Transcranial Magnetic Stimulation (rTMS) is effective and safe treatment option for patients with major depressive disorder (MDD). The Psychiatric Hospital "Sveti Ivan" has the first TMS laboratory with rTMS and deep TMS (dTMS) in Croatia. The objective of this study was to assess the efficacy, safety and tolerability of augmentative rTMS treatment vs standard treatment in Croatian patients with major depressive disorder (MDD).
  
  
  METHODS
  Total of 93 MDD patients were enrolled; 41 of them were treated by augmentative rTMS and 52 were treated by standard (psychopharmacotherapy and psychotherapy) therapy only. We delivered rTMS to the left dorsolateral prefrontal cortex at 120% motor threshold (10 Hz, 4-second train duration), 3000 pulses per session using a figure-eight coil, minimum of 20 sessions during four weeks. Our key outcome was the change in Hamilton Depression Scale (HAM-D17) result from baseline to 4thweek. Our secondary outcomes were changes in Hamilton Anxiety (HAM-A) and WHOQOL-BREF scales.
  
  
  RESULTS
  After four weeks the changes of HAM-D17 and HAM-A results were significantly different between the group of patients treated by augmentative rTMS (48% and 53% decrease, respectively) and the group of patients treated by the standard therapy alone (24% and 30% decrease) (P=0.004, P=0.007). Absolute benefit increase defined as the difference between rates of remission (HAM-D17 ≤7) in rTMS and control group was 33% (P=0.001). Number of patients needed to treat with rTMS in order to achieve remission in one patient was NNT=3. In a group of patients treated with augmentative rTMS 21/41 (51%), and in control group 17/52 (33%) were responders (P=0.071).
  
  
  CONCLUSIONS
  It seems that augmentative treatment with rTMS is more effective on depression and anxiety symptoms than standard therapy in MDD with equal safety and tolerability. Randomized, controlled studies are required to verify this finding.
authors.affiliation: Psychiatric Hospital "Sveti Ivan", Jankomir 11, pp68, HR-10 090 Zagreb, Croatia, igor.filipcic@pbsvi.hr.
authors.forename: Igor
authors.initials: I
authors.lastname: Filipcic
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Milovac
authors.forename: Strahimir
authors.initials: S
authors.lastname: Sucic
authors.forename: Tomislav
authors.initials: T
authors.lastname: Gajsak
authors.forename: Ivona Simunovic
authors.initials: IS
authors.lastname: Filipcic
authors.forename: Ena
authors.initials: E
authors.lastname: Ivezic
authors.forename: Vjekoslav
authors.initials: V
authors.lastname: Aljinovic
authors.forename: Ivana
authors.initials: I
authors.lastname: Orgulan
authors.forename: Sandra Zecevic
authors.initials: SZ
authors.lastname: Penic
authors.forename: Zarko
authors.initials: Z
authors.lastname: Bajic
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy; D017523:Croatia; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome