|Year : 2011 | Volume
| Issue : 2 | Page : 145-148
Utility of repetitive transcranial magnetic stimulation as an augmenting treatment method in treatment-resistant depression
Venu Gopal Jhanwar, Ram Jeevan Bishnoi, Lakshman Singh, MR Jhanwar
Department of Psychiatry, Deva Mental Health Care, Deva Institute of Health Care and Research Pvt. Ltd., Varanasi, Uttar Pradesh, India
Background: About 30-46% of patients with major depressive disorder (MDD) fail to fully respond to initial antidepressants. Treatment-resistant depression is a severely disabling disorder with no proven treatment options; novel treatment methods, such as repetitive transcranial magnetic stimulation (rTMS) can be used as augmentation to ongoing pharmacotherapy or as a solitary method of treatment.
Aim: To evaluate the utility of rTMS as an augmenting method in treatment-resistant depression.
Materials and Methods: In an open-label study, 21 patients with DSM-IV MDD without psychotic features who had failed to respond to an adequate trial of at least 2 antidepressants were given rTMS therapy for 4 weeks keeping the dose of pre-existing antidepressants unchanged. High-frequency (10 Hz) stimulations were delivered over left dorsolateral prefrontal cortex at an intensity of 110% of the patient's motor threshold. Treatment response was defined as a reduction in score on the Hamilton Rating Scale for Depression (HAM-D) from baseline to end of treatment. Secondary efficacy measures included scores on the Clinical Global Impressions-Change and -Severity scales.
Results: At the end of 4 weeks, 19 patients completed the 4 weeks study and were assessed. In ITT analysis the mean HAM-D17 scores were reduced from 30.80±5.00 to 19.00±6.37 (t=8.27, P<0.001). Only 4 patients reported headache but there was no discontinuation due to adverse effects.
Conclusions: The study indicates the potential utility of rTMS as an augmenting agent in treatment-resistant depression. Adequately powered, randomized controlled trials are necessary to evaluate the role of rTMS in treatment-resistant depression.
Venu Gopal Jhanwar
Deva Mental Health Care, Deva Institute of Health Care and Research Pvt. Ltd., Varanasi, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
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