Repetitive transcranial magnetic stimulation (rTMS) in pharmacotherapy-refractory major depression: comparative study of fast, slow and sham rTMS

• Published in: Psychiatry research Vol. 88; no. 3; pp. 163 - 171
• Main Authors: Padberg, Frank, Zwanzger, Peter, Thoma, Heike, Kathmann, Norbert, Haag, Clemenz, D. Greenberg, Benjamin, Hampel, Harald, Möller, Hans-Jürgen
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 29.11.1999; Elsevier
• Subjects: Adult; Affective disorders; Aged; Analysis of Variance; Biological and medical sciences; Brain - physiopathology; Depressive Disorder, Major - physiopathology; Depressive Disorder, Major - therapy; Double-Blind Method; Female; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Neuropsychological Tests; Physical Stimulation - methods; Prefrontal cortex; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Reaction Time; Transcranial Magnetic Stimulation - therapeutic use; Treatment; Treatment Outcome; Treatments; Verbal Learning; Verbal memory; Reaction time; Verbal memory; Treatment; Prefrontal cortex; Affective disorders; Mood disorder; Human; Memory disorder; Cognitive disorder; Depression; Transcranial route; Magnetic stimulus; Complication; Application method; Comparative study
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/S0165-1781(99)00092-X

In previous studies, fast repetitive transcranial magnetic stimulation (rTMS) with a frequency >1 Hz demonstrated substantial antidepressant effects compared to sham rTMS. However, it is not clear whether fast rTMS is superior to slow rTMS (frequency ≤1 Hz) which is safe at therapeutically promising higher intensities. The aim of this double-blind study was to compare the action of fast, slow and sham rTMS. Eighteen patients with pharmacotherapy-resistant major depression were randomized to receive fast (10 Hz), slow (0.3 Hz) or sham rTMS with 250 stimuli/day for 5 successive days. rTMS was applied at 90% motor threshold intensity to the left dorsolateral prefrontal cortex. Scores on the Hamilton Depression Rating Scale (HDRS), but not on the Montgomery–Åsberg Depression Rating Scale (MADRS), showed a statistically significant time×group interaction with a reduction of 19% after slow rTMS. However, the effect was clinically marginal and not reflected by self-rating scores. Verbal memory and reaction performance were not impaired after rTMS, and there was even a statistically significant time×group interaction with improvement of verbal memory performance after fast rTMS. In conclusion, this study further supported the safety of rTMS but does not show any clinically meaningful antidepressant efficacy of rTMS at 250 daily stimuli over 5 days in pharmacotherapy-refractory major depression.