A randomized clinical trial of repetitive transcranial magnetic stimulation in the treatment of major depression

Background: Multiple groups have reported on the use of repetitive transcra nial magnetic stimulation (rTMS) in treatment-resistant major depression. T he purpose of this study is to assess the efficacy of rTMS in unmedicated, treatment-resistant patients who meet criteria for major depression. Methods: Depressed subjects, who had failed to respond to a median of four treatment trials, were assigned in a randomized double-blind manner to rece ive either active (n = 10; 20 2-sec trains of 20 Hz stimulation with 58-sec intervals; delivered at 80% motor threshold with th figure-of-eight coil p ositioned over the left dorsolateral prefrontal cortex) or sham (n = 10; si milar conditions with the coil elevated and angled 45 degrees tangentially to the scalp) rTMS. These sequences were applied during 10 consecutive week days. Continuous electroencephalogram sampling an daily motor threshold det erminations were also obtained. Results: The group mean 25-item Hamilton Depression Rating Scale (HDRS) sco re was 37.2 (+/- 2.0 SEM) points. Adjusted mean decreases in HDRS scores we re 14.0 (+/- 3.7) and 0.2 (+/- 4.1) points for the active and control group s, respectively (p < .05). One of 10 subjects receiving active treatment de monstrated a robust response (i.e., HDRS decreased from 47 to 7 points); th ree other patients demonstrated 40-45% decreases in HDRS scores. No patient s receiving sham treatment demonstrated partial or full responses. Conclusions: a 2-week course of active rTMS resulted in statistically signi ficant but clinically modest reductions of depressive symptoms, as compared to sham rTMS in a population characterized by treatment resistance. Biol P sychiatry 2000;47:332-337 (C) 2000 Society of Biological Psychiatry.