• Quote of the Day
    "Don't let what you can't do interfere with what you can do."
    John Wooden, posted by David Baxter

David Baxter

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Transcranial Magnetic Stimulation Little Help in Severe Depression
Jan 31, 2007

NEW YORK (Reuters Health) -- In patients with severe depression, repetitive transcranial magnetic stimulation (TMS) is much less effective than electroconvulsive therapy (ECT), UK researchers report in the January issue of the American Journal of Psychiatry.

"We were disappointed," lead investigator Dr. Declan M. McLoughlin told Reuters Health." However, he added, "Our trial confirms that in 'real world' conditions, ECT is quite effective for treating severe treatment-resistant depression. In addition, we found ECT to be both clinically and statistically significantly much better than TMS."

Dr. McLoughlin of King's College, London, and colleagues studied 46 patients with major depression. They were randomized to receive a 15-day course of repetitive TMS of the left dorsolateral prefrontal cortex or a standard course of ECT.

At the end of treatment, Hamilton Depression Rating Scale scores were significantly lower in the ECT group. Thirteen (59%) of this group achieved remission, compared with four (16.7%) of the TMS group. In addition, rating for items such as a visual analogue mood scale showed more benefit in the ECT group.

At 6 months, there were no differences in the Hamilton rating between groups. However, other measures showed continued improvement in the ECT group.

"Clinicians can therefore reassure their patients about the effectiveness of ECT for treating depression," said Dr. McLoughlin.

Regarding TMS, he concluded, "Clinicians can advise their patients that this cannot yet be recommended for routine clinical practice and requires further rigorous evaluation."

Am J Psychiatry 2007;164:73-81.
 
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I'm curious, how is "severe depression" defined? Or is there a specific definition?
 

David Baxter

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It doesn't have a precise definition or meaning. It's more a generic term used to describe the severity or intensity of the symptoms. It might also be used in some cases to refer to depression that is intense and not responding to more conventional treatment.
 
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So it would be subjective? One person's severe depression might be different from another person's?
 

David Baxter

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Not really. It's just not a precise term.

Some of the online or self-help screening tests for depression might label someone as "severely depressed', for example, where a clinician would probably call it "moderately depressed".

But as I said, these are imprecise terms.
 

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