Repetitive transcranial magnetic stimulation is as effective as electroconvulsive therapy in the treatment of nondelusional major depressive disorder: An open study

Background: Repetitive transcranial magnetic stimulation (rTMS), a new meth od for the stimulation of the central nervous system, is being proposed as a potential new treatment in patients with major depressive disorder (MDD). We tested the hypothesis that rTMS would be as effective as electroconvuls ive therapy (ECT) in patients with MDD. Methods: Forty patients with MDD referred for ECT were randomly assigned to either ECT or rTMS. Repetitive transcranial magnetic stimulation was perfo rmed at 90% power of the motor threshold. The stimulation frequency was 10 Hz for either 2 sec (first eight patients) or 6 sec (final 12 patients) for 20 trains. Patients were treated for up to 20 treatments days. Electroconv ulsive therapy was performed according to standard protocols. Results: Overall patients responded best to ECT (chi(2) = 3.8, p < .05). Pa tients with MDD and psychosis responded significantly better to ECT (chi(2) = 9.2, p < .01), whereas MDD patients without psychosis responded similarl y to both treatments (chi(2) = 0.0, ns). The analysis of variance with repe ated measures of clinical variables for the whole sample revealed significa nt treatment effects for both groups; however, interaction between group an d treatment was seen only for the Global Assessment of Function and the Sle ep assessment. When the psychosis-nonpsychosis grouping was considered, pat ients with psychosis responded dramatically better to ECT in all assessment s, whereas those without psychosis responded similarly to both treatments. Conclusions: Overall ECT was a more potent treatment for patients with MDD, this being particularly evident in patients with MDD and psychosis; howeve r, in patients with MDD without psychosis the effects of rTMS were similar to those of ECT. The results we report are encouraging and support an impor tant role for rTMS in The treatment of severe MDD; however, additional blin ded studies are needed to precisely define this role. Biol Psychiatry 2000; 47:314-324 (C) Society of Biological Psychiatry.