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J ECT. 2011 Mar;27(1):26-32. doi: 10.1097/YCT.0b013e3181d77645.

Low-frequency repetitive transcranial magnetic stimulation inferior to electroconvulsive therapy in treating depression.

Author information

1
Aarhus University Hospital, Risskov, Denmark. poulhans@rm.dk

Abstract

OBJECTIVES:

Repetitive transcranial magnetic stimulation (rTMS) is a potential new antidepressant method and alternative to electroconvulsive therapy (ECT). The efficacy of right prefrontal low-frequency rTMS was shown in a previous placebo-controlled, randomized study but has never been compared with ECT. The aim of this study was to compare the antidepressant efficacy and adverse effects of right prefrontal low-frequency rTMS with that of ECT.

METHODS:

Sixty inpatients with major depression were randomized to 15 days of 1-Hz right prefrontal rTMS or 9 unilateral ECTs. Depressive symptoms and adverse effects were recorded using the Hamilton Scale for Depression and the Udvalg for Kliniske Unders√łgelser side effect scale, supplied by neuropsychological assessment of cognitive functions.

RESULTS:

Repetitive transcranial magnetic stimulation was significantly less effective than ECT. The intention-to-treat analysis revealed a 26% (confidence interval, 3%-51%) higher rate of partial remission (P = 0.035) by the end of week 3. There was no difference found between the 2 methods on the Udvalg for Kliniske Unders√łgelser rating scale. However, psychological examination revealed ECT to have more adverse effects on cognitive functions, whereas the rTMS group improved particularly with respect to visual memory.

CONCLUSIONS:

Repetitive transcranial magnetic stimulation was significantly less effective than ECT, but ECT had more adverse effects on cognitive function. The outcome does not point to right frontal low-frequency rTMS using the present stimulus design as a first-line substitute for ECT, but rather as a treatment option for patients with depression who are intolerant to other types of treatment or not accepting ECT.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00299403.

PMID:
20351570
DOI:
10.1097/YCT.0b013e3181d77645
[Indexed for MEDLINE]

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