A double-blind sham controlled study of right prefrontal repetitive transcranial magnetic stimulation (rTMS): Therapeutic and cognitive effect in medication free unipolar depression during 4 weeks

Abstract

Background Transcranial magnetic stimulation (TMS) has become a therapeutic tool in psychiatric diseases. Methodology The objective was to evaluate the efficacy of TMS in unipolar depression: the percentage of responders (> 50% HDRS reduction) and remission (HDRS score ≤ 8, after four weeks of active TMS treatment in depressed patients free of any antidepressive agent versus placebo-TMS. Results 27 patients were randomized in two groups: rTMS ( N = 11) versus sham TMS ( N = 16). Statistical differences were detected between sham and TMS treated groups on remission (0 / 16 versus 4 / 11 p = 0.032, 1 / 16 versus 6 / 11 0.028 and 1 / 16 versus 7 / 11 p = 0.011 at day 14, day 21 and day 28, respectively) and on response (2 / 16 versus 5 / 11 at day 14 (NS), 2 / 16 versus 7 / 11 p = 0.0115 at day 21 and 1 / 16 versus 7 / 11 ( p = 0.025) day 28, respectively, using the exact Fisher test). Significant differences were observed between day 1 versus day 8 ( p < 0.01), day 15, day 21 and day 28 ( p < 0.001) in TMS group and only versus day 21 ( p < 0.01) and day 28 ( p < 0.05) for the sham group. ANOVA comparison between TMS and sham groups was significant at day 14 and day 28 ( p < 0.05). Limitations The few number of patients. Conclusion Our study has shown an efficacy of right rTMS in free medication unipolar depression over a month. Nevertheless, number of patients included is limited and multicentric studies will be necessary to specify the antidepressive action of TMS.