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David Baxter

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rTMS shows prolonged antidepressant effect
29 March 2007
Psychiatry Res 2007; 150: 181?186

Depression can be relieved through daily left prefrontal cortex repetitive transcranial magnetic stimulation (rTMS), say researchers.

"The rationale for the use of lateralized TMS is based on the hypothesis that mood disorders may result from a relative imbalance of the frontal lobes," explain Marco Bortolomasi (Casa di Cura "villa S Chiara", Verono, Italy) and colleagues.

The researchers studied 19 patients with major depression who received five sessions of high frequency rTMS or sham stimulation to the left frontal lobe every week for a month.

Each active rTMS session consisted of 800 stimuli/day delivered in 20 trains of 20-Hz at 90% of the motor evoked potential threshold

After just 1 week of active treatment, the patients' depressive symptoms had reduced significantly, with further improvement over the 4 weeks of treatment.

On the Beck Depression Inventory (BDI), scores fell from 25.42 at baseline to 12.25 after 1 week of treatment and to 11.67 after 4 weeks of treatment. The respective Hamilton Depression (HAMD) Rating Scale scores fell from 25.17 to 11.33 and 11.42.

Patients treated with active rTMS did not revert to their pre-treatment depressive mood state until 3 months after active treatment.

The active treatment was well tolerated, with no adverse effects except for mild cephalgia reported by three patients treated with anti-inflammatory drugs.

The researchers say that rTMS may be a suitable adjunct to antidepressant drug treatment.

"Given the substantial delay in symptomatic improvement seen with traditional antidepressant medication another potential use of TMS might be in augmenting or hastening the clinical response in pharmacologically treated patients," they write in the journal Psychiatry Research.

The team adds that subjective drowsiness was seen in all patients treated with rTMS, which has important clinical implications given that most of the patients suffered from insomnia prior to treatment.

"The results of this study justify further clinical research in rTMS with particular emphasis on its long-term effects," conclude Bortolomasi et al.

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