A Comparison of Transcranial Magnetic Stimulation and Electroconvulsive Therapy in Non-delusional Major Depression. A replication Study

 

Leon Grunhaus, Pinhas D Dannon, Shaul Schreiber

Psychiatry Division Sheba Medical Center

 

Increasing evidence suggests that Transcranial Magnetic Stimulation (TMS) is an effective treatment for patients with major depression. Although many technical issues remain unresolved studies published in recent years support the contention that both repetitive TMS (magnetic pulses administered at a frequency of 10Hz) over the left dorsolateral prefrontal cortex, and slow TMS (magnetic pusles at a frequency of 1 Hz) over the right dorsolateral prefrontal cortex are effective antidepressants. Recently, we published the results of a comparison of rTMS and ECT in patients with major depression. The major finding of this study was that rTMS and ECT were comparable treatments in non-delusional major depression, while ECT was vastly superior in delusional major depression.

 

To improve on our previous study we enlarged our sample of non-delusional depressives. Ratings were performed by blind raters and patients treated with ECT were restricted in the medications taken during the course. ECT was performed according to established protocols. RTMS was performed over the left dorsolateral prefrontal cortex. 1200 magnetic stimulations were administered on a daily basis for 20 days at 90% motor threshold. All patients signed an informed consent for participation in research.

 

Preliminary analysis of the data (18 patients per group) suggests that rTMS and ECT are equally effective in this population of very sick and medication resistant depressives. We conclude that a trial of rTMS should be attempted in non‑delusional major depression patients before a course of ECT is pursued.

 

In addition we explored the potential value of exploring cortical excitability during rTMS. We performed cortical output maps at 120% motor threshold (baseline, 15 and 30 minutes after the 1200 pulses) before the first rTMS and after every fifth treatment. Preliminary analysis of the data suggests that an exitatory response following the first treatment was associated with a positive response to rTMS. The findings in patients will be compared with those of normal controls.

 

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