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Adjunctive treatment with transcranial magnetic stimulation in treatment resistant depression: a randomized, double-blind, sham-controlled study

Author(s): Xuan Hong ZHANG | Li Wei WANG | Ji Jun WANG | Qiang LIU | Ye FAN

Journal: Shanghai Archives of Psychiatry
ISSN 1002-0829

Volume: 23;
Issue: 1;
Start page: 17;
Date: 2011;
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Keywords: Treatment resistant depression | Repetitive transcranial magnetic stimulation (rTMS) | Efficacy | Cognitive functions

Background: High-frequency repetitive transcranial magnetic stimulation (rTMS) to the left prefrontal cortex is a promising antidepressant treatment but the appropriate duration of treatment andits effect on cognitive symptoms in treatment resistant patients is uncertain.Hypotheis: Patients with treatment resistant depression on standard antidepressant medication who receive four weeks of adjunctive treatment with high-frequency rTMS to the left prefrontal cortex will have better clinical outcomes and better cognitive functioning than those who receive sham rTMS treatments.Methods: Thirty patients with treatment resistant depression (defined as failure to respond to two or more antidepressants of different classes administered for at least 6 weeks at or above two-thirds of the recommended maximum dose) receiving selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors wererandomly assigned to receive adjundive treatment with either real rTMS (n=15) or sham rTMS (n=15) 5 times a week for 4 conseculive weeks. Blinded pre-post evaluations were conducted using the 17-item Hamilton Depression Rating Scale (HAMD), the Montgomery-Asberg Depression Rating Scale (MADRS), the severity of illness measure from the Clinical Global Impression Rating scale(CGI-S), the Wechsler Adult Intelligence ScaIe (WAIS), the Wechsler Memory Scale (WMS), and the Wisconsjn Card Sorting Test(WC5T).Results:14 subjects from each group completed the study. There was no significant difference in the HAMD total scores between the two groups after 2 weeks of treatment but after 4 weeks of treatment the mean percentage drop in the HAMD total score was significantly greater in the real rTMS group (49%, SD=19%) than in the sham rTMS group(29%, SD=25%), with a mean difference of 20% [95%CI=3%-37%;t26=2.42; P=0.023]. At 4 weeks the mean (SD) reduction in the MADRS total score was also greater in the real rTMS group [47%(23%) vs 16%(40%), Mann-Whitney Z=2.62, P=O.009], but there was no significant difference in the reduction of CGl-S scores between the two groups. Neither of the groups had significant pre-post changes in intelligence, memory or executive functioning.Conclusion:Repetitive transcranial magnetic stimulation is an effective adjunctive treatment for the affective symptoms of treatment resistant depression if administered for at least 4 weeks, but it has no apparent effect on cognitive functioning.
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