Table 22Efficacy of rTMS versus sham: Tier 3 MDD and ≤ 20 percent bipolar disorder

Author, year
Study Design
Primary endpoint(s)
Quality
Tier
Intervention and Sample Size
Study Details
Population CharacteristicsChange in Depressive SymptomsResponse
Remission
Bortolomasi et al., 200690
1 week, all reported patients included in analysis
Did not require failure in the current episode
Tier 3—“drug resistance” not defined
Fair
rTMS (n = 12)
High frequency, 5 sessions
Sham (n = 7)
Treatment strategy
Augmentation
Diagnosis
Bipolar (%)
rTMS: 16.7
Sham: 14.3
Mean number of failed antidepressant trials:
rTMS: NR
Sham: NR
Baseline Depression:
HAM-D24
rTMS: 25.17
Sham: NR
HAM-D24
Change, mean (SD)
rTMS: -13.84
Sham: NR
P = data NR but text states not significant
HAM-D24
Response, n (%)
NR
Remission, n (%)
NR
George et al., 199791
Crossover, 2 weeks
Tier 3—all patients had 1+ implied current episode failures
Fair
rTMS (n = 12)
High frequency, 10 sessions
Sham (n = 12)
Treatment strategy
Mixed-within group difference Patients discontinued their (failed) ADs with the exception of 3 patients who were partial responders
Diagnosis
Bipolar (%)
Overall: 8.3
Mean number of failed antidepressant trials:
Overall: 13.4
Baseline Depression:
HAM-D21
Overall: 28.5 (4.2)
HAM-D21
Change, mean (SD)
rTMS: -5.25
Sham: +3.33
P < 0.03
HAM-D21
Response, n (%)
NR
Remission, n (%)
NR
Moller, 200692 Crossover, within 1 week of completing 1 week of txt
Did not require failure in the current episode.
Tier 3—TRD not defined
Fair
rTMS (n = 10)
High frequency, 5 sessions
Sham (n = 10)
Treatment strategy
Augmentation
Diagnosis
Bipolar (%)
Overall: 20
Mean number of failed antidepressant trials:
rTMS: NR
Sham: NR
Baseline Depression:
HAM-D17
Median (range)
rTMS: 20 (13-37)
Sham: 16 (7-31)
HAM-D17
Change (median)
rTMS: -7
Sham: -1
P = 0.075
HAM-D17
Response, n (%)
NR
Remission, n (%)
NR

Ads = antidepressants; ; HAM-D17 = 17-item Hamilton Depression Scale; HAM-D21 = 21-item Hamilton Depression Scale; HAM-D24 = 24-item Hamilton Depression Scale; n = number; NR = not reported; P = p-value; rTMS = repetitive transcranial magnetic stimulation; SD = standard deviation; TRD = treatment-resistant depression; txt = treatment

From: Results

Cover of Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults
Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults [Internet].
Comparative Effectiveness Reviews, No. 33.
Gaynes BN, Lux LJ, Lloyd SW, et al.

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