More threads by David Baxter PhD

David Baxter PhD

Late Founder
Volume 36, Issue 2, Page 17 (February 2008)
rTMS Still Is Not Recommended for Resistant Depression
February 15, 2008

MONTREAL ? Only one-quarter of patients with treatment-resistant depression respond adequately to repetitive transcranial magnetic stimulation, according to a systematic review of 20 randomized controlled trials.

?Even though it is available in many centers, the overall impression is that repetitive transcranial magnetic stimulation [rTMS] is not recommended for clinical use,? said Dr. Raymond W. Lam, professor and head of the division of clinical neuroscience in the department of psychiatry at the University of British Columbia, Vancouver.

Speaking at the annual conference of the Canadian Psychiatric Association, Dr. Lam said that rTMS uses high-intensity magnetic fields to stimulate cortical neurons.

His study (in press, Canadian Journal of Psychiatry) shows that, with a response/remission rate of 25%, rTMS is significantly more effective than is sham therapy (6%). ?But the overall response/remission rates are still low,? he said, so ?it's hard to counsel a patient to go through this effort, and this expense. That's tough when it's a fairly inconvenient therapy.?

Although it is noninvasive, requires no anesthesia, and has no side effects to speak of, rTMS is expensive and requires daily application. Additionally, studies have examined the effects of short-term therapy only?up to 2 weeks?and there are few follow-up studies. ?After [patients] respond, do they need to continue maintenance rTMS? Do they need to go back on medication? We don't have good answers,? he said.

Only randomized controlled trials with both active and sham treatments were included in the review. Other inclusion criteria were a primary diagnosis of major depressive disorder, no other psychiatric comorbidities, an explicit definition of treatment-resistant depression that specified at least one treatment failure, a prespecified outcome measure, and a clear description of rTMS parameters.

?There are a lot of rTMS parameters that can be manipulated in terms of the frequency, the amount of stimulation, the intensity, and so on,? said Dr. Lam. ?One of the issues has been trying to decide what parameters are optimal, and there is increasing consensus on this.?
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