Lack of a therapeutic effect of a 2-week sub-threshold transcranial magnetic stimulation course for treatment-resistant depression.
Boutros NN, Gueorguieva R, Hoffman RE, Oren DA, Feingold A, Berman RM.
Psychiatry Res. 2002 Dec 30;113(3):245-54.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT
06510, USA.

Stimulation parameters seem to strongly influence the efficacy of repetitive
transcranial magnetic stimulation (rTMS) in the management of
treatment-resistant depressed patients. The most effective and safest parameters
are yet to be defined. Moreover, systematic follow-up data available to document
the duration of the therapeutic effects remain sparse. Twenty-one
treatment-resistant depressed patients were randomized to either active rTMS
(N=12) or to sham (N=9) treatment in a double-blind design. Patients were kept
on their medications. Sub-motor-threshold (MT) stimulation (80% MT) was
delivered for 10 consecutive work days (20 Hz, 2-s trains, 20 trains). Subjects
meeting pre-set criteria for responding were entered into a follow-up phase for
up to 5 months. Utilizing the above stimulation parameters, we found no
significant difference between groups. Six patients in the active group and one
subject in the sham group met criteria for the follow-up phase. The period of
time before subjects met criteria for relapse was highly variable ranging from 2
to 20 weeks. Sub-threshold rTMS stimulation for 2 weeks is not significantly
superior to sham treatment for treatment-resistant depressed patients. The
duration of the therapeutic effects of rTMS delivered to the left prefrontal
cortex using the above-described parameters is highly variable.




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