A Randomized Controlled Trial of rTMS Augmentation in Depression

SOURCE: Indian Journal of Psychiatry. Conference: 69th Annual Conference of Indian Psychiatric Society, ANCIPS 2017. Raipur India. 59(Supplement 2) (pp S196), 2017. Date of Publication: January 2017.

AUTHORS: Shrivastava A.; Singh J.; Dalal P.K.; Sharma E.; Kar S.K.

BACKGROUND: Major depression is a serious disorder of great clinical and sociological importance. Resistance to the available treatment strategies is observed in 30-40% of patients. To date mainly effectiveness of high frequency rTMS has been studied in major depressive disorder. However, studies on low frequency RTMS also provided equal effectiveness and better tolerability profile.

AIM(S): To study the efficacy of RTMS augmentation in depression with inadequate response to antidepressant(s).

METHOD(S): The study was a randomized, double blind, SHAM controlled trial of 3 week duration with 3 week follow up period. 29 Major depression patients were randomly assigned to receive 18 sessions of real TMS (14 patients) or SHAM TMS (15 patients) of the right dorsolateral prefrontal cortex as adjuvant treatment to pharmacotherapy. The main stimulation parameters were low frequency (1hz) RTMS with 60 pulses/train in 20 trains at 100% of the resting motor threshold over right dorsolateral prefrontal cortex (DLPFC). Blinded external evaluators administered the Montgomery
Asberg depression rating scale. Statistical analysis used were fisher exact test and unpaired t test.

RESULT(S): Low frequency rTMSs showed significant improvement in the true rTMS group starting from second week onwards. Improvement was also sustained at 3 week follow up. Response rate was significantly higher in true rTMS group as compared to sham rTMS group; 85.7% In true rTMS and 13.3% In sham group (p<0.0001). Headache was the only side effect that was observed in both the groups.

CONCLUSION(S): Low frequency RTMS over right DLFPC is better than sham rTMS in patients of depression.

LINK TO FULL ARTICLE: https://journals.lww.com/indianjpsychiatry/toc/2017/59002