Objective: Many severely depressed patients do not benefit from or tolerate existing treatments. Repetitive transcranial magnetic stimulation (rTMS) has been reported to benefit depression. We compared rTMS to electroconvulsive therapy (ECT) in a more severely ill, depressed group.
Design: Thirty-one patients ranging in age from 18 to 72, with a major depression (unipolar or bipolar) deemed clinically appropriate for ECT, were randomly assigned to rTMS (10-20 treatments, 10 Hz, 110% motor threshold applied to the left dorsolateral prefrontal cortex for a total of 10,000 to 20,000 stimulations) or a course of bitemporal ECT (4-12 treatments).
Materials and Methods: The primary outcome measure was the 24-item Hamilton Depression Rating Scale (HDRS). The Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMS) and Clinical Global Impression scale (CGI) were secondary measures. Minimal rescue medications were utilized.
Results: Mean percent improvement on the baseline HDRS score did not significantly differ between the two treatments (i.e., 51 % for the rTMS group versus 69% for the ECT group (p=ns)). With response defined as a 50% reduction from baseline and a final score < 8 on the HDRS, there was also no significant difference between the two groups. There is a report that older age (> 65) is associated with poorer rTMS outcome (Figiel et al., 1998). In a post hoc examination of subjects responding to rTMS (n=7), we found no correlation between the number of treatments to achieve response and age r(5)=.35, p=ns. The implications of this will be discussed.
Conclusion: A 2 to 4 week randomized, prospective trial comparing rTMS to ECT produced comparable therapeutic effects in severely depressed patients across a wide age range.