Abstract
Background: 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 severely ill, depressed patients.
Methods: Twenty-five patients 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 10,000–20,000
stimulations) or a course of bitemporal ECT (4–12 treatments). 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., 55% for the rTMS group vs. 64% 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. We did not observe any differences between groups on
the secondary measures.
Conclusions: A 2–4 week randomized,
prospective trial comparing rTMS to ECT produced comparable
therapeutic effects in severely depressed patients.