Posted by jrbecker on October 21, 2003, at 10:53:53
http://www.medscape.com/viewarticle/463183
Transcranial Magnetic Stimulation Effective for Medication-Resistant Major Depression
Laurie Barclay, MD
Oct. 17, 2003 — Both high-frequency left-sided transcranial magnetic stimulation (HFL-TMS) and low-frequency stimulation to the right prefrontal cortex (LFR-TMS) are effective in the treatment of refractory major depression, according to the results of a randomized, double-blind, placebo-controlled trial published in the October issue of the Archives of General Psychiatry."HFL-TMS has been shown to have antidepressant effects in double-blind trials," write Paul B. Fitzgerald, MBBS, MPM, FRANZCP, from Monash University in Melbourne, Australia, and colleagues. "LFR-TMS has also shown promise, although it has not been assessed in treatment-resistant depression and its effects have not been compared with those of HFL-TMS."
In this sham-controlled trial taking place on two general psychiatric services, 60 patients with multiple antidepressant-resistant depressions were separated into three groups statistically similar in age, sex, and other clinical variables. Daily interventions consisted of 20 five-second HFL-TMS trains at 10 Hz, five 60-second LFR-TMS trains at 1 Hz, or sham stimulation with the coil angled at 45° from the scalp, resting on the side of one wing of the coil.
On the Montgomery-Åsberg Depression Rating Scale, there was a significant difference between the HFL-TMS and sham groups and between the LFR-TMS and sham groups (P < .005 for all) but not between the two treatment groups. Psychomotor agitation at baseline predicted successful treatment response. Repetitive TMS was generally well tolerated, and no major adverse events were reported.
Study limitations include possible type II error explaining the lack of difference between the two active treatments, difficulty in interpreting the extension phase of the study in patients who continued active treatment after the double-blind phase, and inability to determine the value of switching between treatments in patients who did not respond to one stimulation type.
"These data suggest that there is potential value in a trial of HFL-TMS after failed LFR-TMS, but perhaps less value in the opposite. This supports the idea of offering LFR-TMS as a first-line stimulation type with crossover to HFL-TMS in nonresponders," the authors write. "Treatment for at least four weeks is necessary for clinically meaningful benefits to be achieved."
The National Health and Medical Research Council in Canberra, Australia, and the Stanley Medical Research Institute in Bethesda, Maryland, supported this study.
Arch Gen Psychiatry. 2003;60:1002-1008
Reviewed by Gary D. Vogin, MD
poster:jrbecker
thread:271445
URL: http://www.dr-bob.org/babble/20031021/msgs/271445.html