Transcranial magnetic stimulation in the treatment of XXXX : a double-blind, placebo-controlled trial.

@entity1 @entity308 @entity2146 @entity37462
BACKGROUND: High-frequency left-sided repetitive transcranial magnetic stimulation (HFL-TMS) has been shown to have antidepressant effects in double-blind trials. Low-frequency stimulation to the right prefrontal cortex ( @entity37462 -TMS) has also shown promise, although it has not been assessed in treatment-resistant @entity308 and its effects have not been compared with those of HFL-TMS. OBJECTIVE: To prospectively evaluate the efficacy of HFL-TMS and @entity37462 -TMS in treatment-resistant @entity308 and compared with a sham-treated control group. DESIGN: A double-blind, randomized, sham-controlled trial. SETTING: Two general psychiatric services. @entity1 : Sixty @entity1 with treatment-resistant @entity308 who had failed to respond to therapy with multiple antidepressant medications were divided into 3 groups of 20 that did not differ in age, sex, or any clinical variables. All @entity1 completed the double-blind phase of the study. INTERVENTIONS: Twenty 5-second HFL-TMS trains at 10 Hz and five 60-second @entity37462 -TMS trains at 1 Hz were applied daily. Sham stimulation was applied with the coil angled at 45 degrees from the scalp, resting on the side of one wing of the coil. Main Outcome Measure Score on the Montgomery-Asberg Depression Rating Scale. RESULTS: There was a significant difference in response among the 3 groups (F56,2 = 6.2), with a significant difference between the HFL-TMS and sham groups and between the @entity37462 -TMS and sham groups (P<.005 for all) but not between the 2 treatment groups. Baseline @entity2146 predicted successful response to treatment. CONCLUSIONS: Both HFL-TMS and @entity37462 -TMS have treatment efficacy in @entity1 with medication-resistant major @entity308 . Treatment for at least 4 weeks is necessary for clinically meaningful benefits to be achieved. Treatment with @entity37462 -TMS may prove to be an appropriate initial repetitive TMS strategy in @entity308 taking into account safety, tolerability, and efficacy considerations.
