Lack of a therapeutic effect of a 2-week sub-threshold transcranial magnetic stimulation course for treatment-resistant depression.
Boutros NN, Gueorguieva R, Hoffman RE, Oren DA, Feingold A, Berman RM.
Psychiatry Res. 2002 Dec 30;113(3):245-54

Stimulation parameters seem to strongly influence the efficacy of repetitive
transcranial magnetic stimulation (rTMS) in the management of
treatment-resistant depressed patients. The most effective and safest parameters
are yet to be defined. Moreover, systematic follow-up data available to document
the duration of the therapeutic effects remain sparse. Twenty-one
treatment-resistant depressed patients were randomized to either active rTMS
(N=12) or to sham (N=9) treatment in a double-blind design. Patients were kept
on their medications. Sub-motor-threshold (MT) stimulation (80% MT) was
delivered for 10 consecutive work days (20 Hz, 2-s trains, 20 trains). Subjects
meeting pre-set criteria for responding were entered into a follow-up phase for
up to 5 months. Utilizing the above stimulation parameters, we found no
significant difference between groups. Six patients in the active group and one
subject in the sham group met criteria for the follow-up phase. The period of
time before subjects met criteria for relapse was highly variable ranging from 2
to 20 weeks. Sub-threshold rTMS stimulation for 2 weeks is not significantly
superior to sham treatment for treatment-resistant depressed patients. The
duration of the therapeutic effects of rTMS delivered to the left prefrontal
cortex using the above-described parameters is highly variable.




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