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Monday, December 3, 2007

rTMS augmentation not useful


Repetitive Transcranial Magnetic Stimulation (rTMS) together with mirtazapine or venlafaxine was not better than these antidepressants with sham rTMS. Response in both treatment groups was 31%, response defined as a reduction of 50% or more on two of three depression severity scales. Even the decrease of scores on the depression rating scales did not differ significantly between real and sham rTMS.

There was also no accelerated antidepressant effect, no acceleration of a clinical improvement.

There was no influence of age or gender on outcome.

Augmentation means starting a treatment together with another effective treatment. Addition is usually adding a treatment to another treatment after failure of the first treatment. In this study augmentation was used, the antidepressants and real or sham rTMS were started simultaneously.


Method
A multi center randomized double-blind sham controlled trial in Germany (6 centers) and Austria (1 center). No focus on treatment resistant depression.
Inclusion criteria were depressive disorder and bipolar depression, age between 18 and 74.
Sample size was relatively large, n=62 in the real and 65 in the sham condition. It is one of the largest rTMS studies in depression.
Stimulation was applied above the left dorsolateral prefrontal cortex with an intensity of 110% above the individual resting motor threshold.

Another publication with treatment resistant patients and rTMS is not yet published.

Well done research, results are not overvalued and in that sense a relief when compared to US based research and publications. Fortunately European research proofs it's value. A critical concise reproduction of a interesting study in strong contrast with the publication in Biological Psychiatry discussed in this post: At last some good news about rTMS?


Article Discussed:
Br J Psychiatry. 2007 Nov;191:441-8.
Antidepressant effects of augmentative transcranial magnetic stimulation:
randomised multicentre trial.
Herwig U, Fallgatter AJ, Höppner J, Eschweiler GW, Kron M, Hajak G, Padberg F,
Naderi-Heiden A, Abler B, Eichhammer P, Grossheinrich N, Hay B, Kammer T,
Langguth B, Laske C, Plewnia C, Richter MM, Schulz M, Unterecker S, Zinke A,
Spitzer M, Schönfeldt-Lecuona C.

PMID: 17978325
Blogging on Peer-Reviewed Research



1 comment:

herb said...

Hi doc,

Transcranial magnetic stimulation: An effective treatment for depression

http://www.eurekalert.org/pub_releases/2007-12/e-tms120507.php

I don’t know if this is the same or new study you’ve been chatting about. I would like to know what you think if you read the study results.

Warmly,
Herb
VNSdepression.com