Modest adjunctive benefit with transcranial magnetic stimulation in medication-resistant depression

Background: Controverted results have been obtained using high frequency tr anscranial magnetic stimulation (HF-rTMS) as an antidepressant treatment. M ethod: Forty patients suffering from drug-resistant major depression receiv ed ten sessions of HF-rTMS at 90%: of the motor threshold on the left prefr ontal cortex or sham stimulation, added to their pharmacological treatment, in a randomized double-blind design. In a second open phase, patients stil l fulfilling criteria of inclusion received ten additional sessions of HF-r TMS at 90 or 110%. Results: Real, but not sham HF-rTMS, was associated with a significant decrease in the Hamilton Depression Rating Scale, but only t welve patients decreased more than 50%. Conclusions: Left prefrontal HF-rTM S was effectively associated with antidepressant treatment, although the si ze effect was small. Limitations: Shortage of the sample and control diffic ulties of the placebo effect. Clinical relevance: Questionable in more than half of the patients studied. (C) 2001 Elsevier Science B.V. All rights re served.