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Transcranial Magnetic Stimulation for Refractory Depression

A new technology -- transcranial magnetic stimulation (TMS) -- stimulates neurons of the cerebral cortex. This report presents the outcome of six treatment-refractory depressed patients treated with TMS.

The patients were a mean age of 46.5 years and had a mean baseline Ham-D Rating Scale score of 23.8. One patient was diagnosed with unipolar depression and five with bipolar II depression. All patients received 20 two-second trains of TMS at 20 Hz over a 20-minute period applied to the left prefrontal region using a hand held figure-eight shaped coil, approximately 5 cm anterior to the surface. This site was chosen to maximally stimulate the left dorsolateral prefrontal cortex. If a clinical response was observed after the first five days of treatment, TMS was continued. Four patients also received placebo compounds and two received carbamazepine.

Overall, the group had significant improvement in mood; mean Ham-D scores decreased from 23.8 at baseline to 17.5 after treatment. Two patients had a robust clinical response, two had a slight clinical response, and two patients who previously were ECT nonresponders had no change. Two patients reported headaches that responded to treatment with a nonsteroidal anti-inflammatory agent or acetaminophen.

Comment: This study suggests that some patients with treatment-refractory depression may respond to TMS. Clearly, placebo-controlled blinded trials are necessary to confirm the safety and efficacy of this treatment and moreover, to determine the optimal characteristics of the treatment (such as intensity, frequency, pattern, and duration) as well as neuroanatomical location and coil design.

— C Nemeroff

Published in Journal Watch Psychiatry June 1, 1996

Citation(s):

George MS et al. Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport 1995 6 1853-1856.

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