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David Baxter

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Magnetic Stimulation May Be Effective Maintenance Therapy for Major Depression

NEW YORK (Reuters Health) Jan 30, 2006 - Repetitive transcranial magnetic stimulation (rTMS) may be an effective and safe long-term maintenance therapy for some patients with major depressive disorder, results of an open-label study published in the December issue of the Journal of Clinical Psychiatry indicate.

"There is growing evidence to support the short-term antidepressant effects of rTMS, but few published data pertain to the maintenance treatment of patients with DSM-IV diagnosed major depressive disorder who have responded acutely to rTMS," write Dr. John P. O'Reardon and colleagues from the University of Pennsylvania, Philadelphia.

The researchers examined the long-term efficacy of rTMS in 10 patients (mean age 50 years) with major depressive disorder over periods ranging from 6 months to 6 years.

rTMS was applied over the left prefrontal cortex at 100% of motor threshold, usually at 10 Hz for 40 trains at 5 seconds per train with a 25-second intertrain interval of no stimulation. Session frequency averaged 1 to 2 per week, and a total of 1831 rTMS sessions were documented.

The physician-rated Clinical Global Impressions-Improvement scale (CGI-I) measure was used to assess the clinical benefits of rTMS maintenance. These ratings were cross-checked with the patients' self-rated global impression of improvement.

Of the 10 subjects, five experienced marked benefit from rTMS therapy. These patients underwent a mean of 257 rTMS sessions at a session frequency of 2.1 per week. Three of the patients did not require any concurrent antidepressant medication.

An additional two patients experienced moderate benefit. These subjects received a mean of 125 rTMS sessions at a session frequency of 1.8 per week. Both experienced a recurrence of major depressive disorder.

"Three patients experienced only minimal benefit from rTMS and received a mean of 98 sessions (1.7 per week) each," Dr. O'Reardon's team notes. "Two of the three patients experienced recurrences of depression, and none maintained a sustained improvement during maintenance therapy despite the addition of antidepressant medication," they write. "In these patients, rTMS was ultimately discontinued due to inadequate results."

The investigators point out that the patients who responded most strongly to acute treatment tended to benefit most from maintenance rTMS, but more research is needed to identify patients who are likely be helped by the modality in the long term.

J Clin Psychiatry 2005;66:1524-1528.
 

Meg

Dr. Meg, Global Moderator, Practitioner
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I think rTMS is a really fascinating idea. I have a friend who is doing her PhD research on this topic, though I think she's investigating its benefits for stroke patients rather than for those with major depression. I will be very interested to know what her results are. I am hoping I will be able to visit her lab and see how it works :)
 

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