A. Pascualleone et al., RAPID-RATE TRANSCRANIAL MAGNETIC STIMULATION OF LEFT DORSOLATERAL PREFRONTAL CORTEX IN DRUG-RESISTANT DEPRESSION, Lancet, 348(9022), 1996, pp. 233-237
Background Lesion and neuroimaging studies suggest that left prefronta
l lobe dysfunction is pathophysiologically linked to depression. Rapid
-rate transcranial magnetic stimulation (rTMS) to prefrontal lateralis
ed effect on mood In normal several preliminary studies suggest a bene
ficial effect of rTMS on depression. However, adequately controlled st
udies have not been conducted. Methods We have studied the effects of
focal rTMS on the depressive symptoms in 17 patients with medication-r
esistant depression of psychotic subtype. The study was designed as a
multiple cross-over, randomised placebo-controlled trial. Sham rTMS an
d stimulation of different cortical areas were used as controls. Findi
ngs Left dorsolateral prefrontal cortex rTMS resulted in a significant
decrease in scores on the Hamilton depression rating scale HDRS (from
25.2 to 13.8) and the self-rated Beck questionnaire BQ (from 47.9 to
25.7). 11 of the 17 patients showed pronounced improvement that lasted
for about 2 weeks after 5 days of daily rTMS sessions. No patient exp
erienced any significant undesirable side-effects. Interpretation Our
findings emphasise the role of the left dorsolateral prefrontal cortex
in depression, and suggest that rTMS of the left dorsolateral prefron
tal cortex might become a safe, non-convulsive alternative to electroc
onvulsive treatment in depression.