Background
We tested whether transcranial magnetic stimulation (TMS) over the left dorsolateral
prefrontal cortex (DLPFC) is effective and safe in the acute treatment of major depression.
Methods
In a double-blind, multisite study, 301 medication-free patients with major depression
who had not benefited from prior treatment were randomized to active (n = 155) or sham TMS (n = 146) conditions. Sessions were conducted five times per week with TMS at 10 pulses/sec,
120% of motor threshold, 3000 pulses/session, for 4–6 weeks. Primary outcome was the
symptom score change as assessed at week 4 with the Montgomery–Asberg Depression Rating
Scale (MADRS). Secondary outcomes included changes on the 17- and 24-item Hamilton
Depression Rating Scale (HAMD) and response and remission rates with the MADRS and
HAMD.
Results
Active TMS was significantly superior to sham TMS on the MADRS at week 4 (with a post
hoc correction for inequality in symptom severity between groups at baseline), as
well as on the HAMD17 and HAMD24 scales at weeks 4 and 6. Response rates were significantly
higher with active TMS on all three scales at weeks 4 and 6. Remission rates were
approximately twofold higher with active TMS at week 6 and significant on the MADRS
and HAMD24 scales (but not the HAMD17 scale). Active TMS was well tolerated with a
low dropout rate for adverse events (4.5%) that were generally mild and limited to
transient scalp discomfort or pain.
Conclusions
Transcranial magnetic stimulation was effective in treating major depression with
minimal side effects reported. It offers clinicians a novel alternative for the treatment
of this disorder.
Key Words
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Article Info
Publication History
Published online: June 16, 2007
Accepted:
January 19,
2007
Received in revised form:
November 25,
2006
Received:
September 29,
2006
Identification
Copyright
© 2007 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
