Comparison of unlimited numbers of rapid transcranial magnetic stimulation (rTMS) and ECT treatment sessions in major depressive episode

Saxby Pridmore'I', Raimondo Bruno3, Yvonne Turnier-Shea', Phil Reid' and Mazena Rybak'
' Discipline of l'sychiafry, University of Tasmania, Hobart, Tasmania ' Department of Psychological Medicine, Royal Hobart Hospital, Tasmania 'School of Psychology, University of Tasmania, Hobart, Tasmania

Repetitive transcranial magnetic stimulation (rTMS) is a new technology which holds promise as a treatment of psychiatric disorders. Most work to date has been on depression, Superiority to placebo has been indicated in three small blind studies. We compared the antidepressant effects of rTMS and ECT in 32 patients suffering major depressive episode (MDE) who had failed to respond to at least one course of medication. There was no limit to the number of treatment sessions which could be given and treatment was continued until remission occurred or response plateaued, A significant main effect for treatment type was found [Pillai trace = 0.248, F(3,28) = 3.076, JI = 0.044; power = 0.6561, reflecting an advantage for ECT patients on measures of depression overall, however, rTMS produced comparable results on a number of measures. Blind raters using the 17.item Hamilton Depression Rating Scale (HDRS) found the rate of remission (HDRS = 
Received 15 August 1999; Revised 7 November 1999; Revised 24 November 1999; Accepted 8 December 1999)

Key words:
Transcranial magnetic stimulation, electroconvulsive therapy, depression.
Journal of Neuropsychopharmacology (ZOOO), 3, 129-134. Copyright 0 2000 CINP

Introduction Transcranial magnetic stimulation (TMS) is a new tech-nology which has potential for investigation and treat-ment in neurology and psychiatry (Pridmore and Belmaker, 1999). The technique involves holding of an insulated coil in contact with the scalp over the region of interest. When a strong current is passed around the coil a magnetic field is created which passes through the scalp and skull and into the brain. Rapidly fluctuating the strength of that current produces fluctuations in the magnetic field, which in turn produces tiny secondary currents (Cadwell, 1989) in proximity to the junction of grey and white matter (Epstein et al., 1990).
Address for correspondence: Professor S. l'ridmore, Department of Psychological Medicine, Royal Hobart Hospital, Hobart Tasmania, Australia, 7000. Tel.: +61 3 6222 8804, Fax: +61 3 6234 7889; E-mail:
In animal studies, rTMS has been found to have similar effects to ECT. Fujiki and Steward (1997) compared the effects of 25 Hz rTMS and electroconvulsive shock (ECS in mice. They found similarities in expression of glia fibrillary acidic protein mRNA. Ji et al. (1998) comparec 25 Hz rTMS and ECS in rats. They found both producec increased immediate early gene expression but in differeni patterns. ECS increased c-fos mRNA throughout the brain particularly in the hippocampus and neocortex. Bl contrast, rTMS increased c-~OS mRNA more discretely particularly in the paraventricular nucleus of the thalamus Fleischmann et al. (1999) applied 20 Hz rTMS to rats ant found that chronic exposure produced increases in seizure threshold similar to those reported for ECS and ECT. In both open (Epstein et al., 1998; George et al., 1995 and blind (Avery et al., 1999; George et al., 1997 Pascual-Leone et al., 1996) clinical trials, rTMS ha! demonstrated antidepressant effects. In the double-blinc clinical trials, however, this effect had been dis appointingly transient (I'ascual-Leone et al., 1996) 01

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