Comparison of repetitive transcranial magnetic stimulation and electroconvulsive therapy in unipolar non-psychotic refractory depression: a randomized, single-blind study

Abstract

Repetitive transcranial magnetic stimulation (rTMS) can induce significant antidepressant effects and, for some patients, might be an alternative to electroconvulsive therapy (ECT). The results of studies comparing the efficacy of rTMS and ECT are mixed and, therefore, comparison of these two therapies needs to be further explored. Forty-two patients aged between 18 and 65 yr, referred to ECT due to unipolar non-psychotic depression refractoriness entered the trial. They were randomly assigned to receive either rTMS or ECT. Depressive symptom changes were blindly measured by Hamilton Depression Rating Scale, Visual Analogue Scale and Clinical Global Impression at baseline, after 2 wk and after 4 wk of treatment. There was no difference in the antidepressant efficacy of ECT and rTMS. Response rates were relatively low in both groups (40% and 50% respectively), with no significant difference between them (p=0.55). Remission rates were also low for both groups (20% and 10% respectively), also with no significant difference (p=0.631). There was no significant difference in the neuropsychological test performance after either one of these therapies. Both treatments were associated with a degree of improvement in refractory depression and therefore add to the literature that rTMS can be an effective option to ECT as it is a less costly treatment and is not associated with anaesthetic and other ECT risks.

The Effects of Repetitive Transcranial Magnetic Stimulation on Cognitive Performance in Treatment-Resistant Depression. A Systematic Review

“…Similarly, Rosa et al [42] suggested that there was no difference in terms of neuropsychological test performance between 42 TRD patients aged between 18 and 65 years who were randomly assigned to receive either rTMS or ECT.…”

“…Based on the main findings, most (16) of the selected studies [23,25,28,37,38,39,40,43,45,46,47,48,49,50,51,54] supported the association between rTMS and neurocognitive effects; only two studies [52,53] suggested the existence of a trend towards improvements in neurocognitive profile using rTMS, and some (4) studies [36,41,42,44] did not confirm this association (tables 1, 2, 3). …”

Low-Frequency rTMS over Right Dorsolateral Prefrontal Cortex in the Treatment of Resistant Depression: Cognitive Improvement Is Independent from Clinical Response, Resting Motor Threshold Is Related to Clinical Response

“…However, many studies failed to demonstrate significant cognitive effects [24,25,26,27,28,29,30], but they could show trends toward selective cognitive improvements. Studies using 1-Hz stimulation are limited because of methodological differences (i.e.…”

O efeito da estimulação magnética transcraniana repetitiva do córtex pré-frontal dorsolateral esquerdo na dor central decorrente de acidente vascular cerebral

“…A metodologia de localização da bobina sobre a região do CPM/CPFDL esquerdo empregado no presente estudo é a mesma utilizada na maioria das pesquisas sobre a EMTr na depressão (PascualLeone et al, 1996;George et al, 2000;Fitzgerald et al, 2002;Rumi et al, 2005;Rosa et al, 2006) (Eisendrath, 1995;Gallagher;Verma, 2004) ou com AVC (Herrmann et al, 1995;Hackett;Anderson, 2005;Loubinoux et al, 2012). A EMTr com frequência superior a 5 Hz do CPFDL esquerdo modula intensamente os circuitos fronto-cingulados envolvidos no controle do humor (Paus et al, 2001) e tem papel estabelecido na terapêutica de doentes com transtornos depressivos (Rumi et al, 2005;O´Reardon et al, 2007;George et al, 2010).…”