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Abstract
Objectives. High frequency left-sided (HFL) and low frequency right-sided (LFR) unilateral repetitive transcranial magnetic stimulation (rTMS) are efficacious in treatment-resistant major depression (TRD). Similar benefit has been suggested for sequential bilateral rTMS (LFR then HFL). There are few published reports on the efficacy of sequential bilateral rTMS compared to HFL and sham rTMS. Therefore, this study evaluated the efficacy of HFL and sequential bilateral rTMS compared to sham in TRD. Methods. Subjects between the ages of 18 and 85 were recruited from a tertiary care university hospital. Seventy-four subjects with TRD and a 17-item Hamilton Depression Rating Scale (HDRS) greater than 21 were randomized to receive unilateral, bilateral, or sham rTMS. The rates of remission were compared among the three treatment groups. Results. The remission rates differed significantly among the three treatment groups using a modified intention to treat analysis that excluded subjects who did not respond to electroconvulsive therapy (ECT) during the current episode. The remission rate was significantly higher in the bilateral group than the sham group. The remission rate in the unilateral group did not differ from either group. Conclusion. These findings warrant larger controlled studies that compare the efficacy of sequential bilateral rTMS and HFL rTMS in TRD.
Acknowledgements
The authors gratefully acknowledge the assistance of all volunteers whose participation was essential in the successful completion of the study. ZJD and DMB had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. This work was funded, in part, by the Ontario Mental Health Foundation (OMHF), Canadian Institutes of Health Research (CIHR) Clinician Scientist Award (ZJD), CIHR Fellowship (DMB), by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship (PBF) and by Constance and Stephen Lieber through a National Alliance for Research on Schizophrenia and Depression (NARSAD) Lieber Young Investigator award (ZJD).
Statement of Interest
DMB reported no biomedical financial interests or potential conflicts of interest. During the past three years, BHM has received research support from Bristol-Meyers Squibb, Eli Lilly, Pfizer and Wyeth; currently, he directly owns stocks (all less than $10,000) of Akzo-Nobel, Alkermes, AstraZeneca, Celsion, Elan, Eli Lilly, Forest, General Electric, and Orchestra Therapeutics. PBF is supported by a NHMRC Practitioner fellowship. He has received research funding from Neuronetics Inc and equipment for investigator initiated research from Magventure A/S and Brainsway Ltd. TKR, AVR, LTY and AJL reported no biomedical financial interests or potential conflicts of interest. ZJD has received research funding from Aspect Medical Inc and Neuronetics Inc; he has also received a travel allowance from Pfizer.