Acceleration
of response to antidepressants by repetitive
transcranial magnetic stimulation
The
antidepressant effect of repetitive transcranial
magnetic stimulation (rTMS) may be due to its
influence on specific mood-regulating brain
circuits and neurobiological effects similar to
some antidepressants. Studies that have
evaluated the use of rTMS in the treatment of
major depression were inconclusive because of
the variability in the stimulation parameters
used and the small sample sizes. Most studies
have tested the efficacy of rTMS in
drug-resistant and severe depression. The aim of
a recent study was to assess the effectiveness
of rTMS as an adjunct to drug therapy in
patients who were not treatment resistant to
determine whether antidepressants might work
better in combination with rTMS.
The 5-week, double blind study involved 99
inpatients with a major depressive episode who
were randomised to receive venlafaxine,
sertraline, or escitalopram combined with 2
weeks of sham or active rTMS. The 15-Hz
stimulation was performed over the left
dorsolateral prefrontal cortex.
Patients treated with the active rTMS
experienced a faster reduction in the Hamilton
Rating Scale for Depression (HAM-D) score than
did patients given the sham treatment (p =
0.0029). At the end of the second week the
response and remission rates were higher in the
active rTMS group than the sham group (p = 0.002
and p = 0.003, respectively). However, at the
end of the fifth week of treatment they were no
longer any significantly differences between the
groups. HAM-D score reduction was similar for
the 3 antidepressant drugs tested in the active
and in the sham groups.
These data show that 2 weeks of rTMS may
accelerate the effectiveness of antidepressant
drugs in patients with major depressive
disorder. The effect of rTMS appear to be
similar with all of the antidepressants
tested. Rossini
D, Magri L, Lucca A, Giordani S, Smeraldi E,
Zanardi R. Does rTMS hasten the response to
escitalopram, sertraline, or venlafaxine in
patients with major depressive disorder? A
double-blind, randomized, sham-controlled trial.
J Clin Psychiatry 2005, 66:1569-1575.