Table 2. Open TMS studies in major depression: patient characteristics, treatment parameters and comments.
| Medication | Stimulus intensity |
Pulse freq.(Hz) |
Train duration(s) |
Number of trains |
Pulses per session |
Total session |
|||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Study | Treatment | Age | Resist | Free | Comment | ||||||
| Hoflich et al. (1993) |
Vertex TMS |
42.0 | Yes | No | 105–130% MT | 0.3 | na | na | 250 | 10 | One patient had slight improvement. |
| George et al. (1995) |
LDLPFC rTMS |
46.5 | Yes | 4/6 | 80% MT | 20 | 2 | 20 | 800 | 5+ | Two robust responders. |
| Grisaru et al. (1995) |
Motor TMS |
39.4 | na | No | 2 T | 0.017 | 3600 | 1 | 60 | 1 | Outcome assessed after single session; 4 mild improvement, 1 worse, 5 no change. |
| Geller et al. (1997) | LPFC and RPFC TMS | 39.4 | na | No | 2.5 T | 0.033 | 900 | 1 | 30 | 1 | Outcome assessed after single session; 3 immediate, lifeting of mood; 2 possible improvement; 1 worsening 4 no change. |
| Epstein et al. (1998) | LDLPFC rTMS | 40.0 | Yes | Yes | 110% MT | 10 | 5 | 10 | 250 | 5 | Age < 65, 4 dropouts, rTMS resulted in HRSD < 10 in 50% of sample. 8/10 with previous favourable response to ECT responded to rTMS (HRSD < 10). Non-responders older than rTMS responders. |
| Figiel et al. (1998) | LDLPFC rTMS | 59.9 | 53/56 | 50/56 | 110% MT | 10 | 5 | 10 | 500 | 5 | Sample overlaps with Epistein study, but includes new sample≥65. Results calculated on 50 patients who completed study. Only 2.3% of ≥65 responded; 56% of those < 65 responded (< 60%HRSD reduction with maximal post score of 16). Only 2 of 8 patients (25%) with psychotic depression responded. |
| Feinsod et al. (1998) | RDLPFC TMS | 58.0 | na | 4/14 | 1 T, 0.1 ms | 1 | 60 | 2 | 120 | 10 | By CGI 6 of 14 (42.9%) MDD patients showed marked improvement. |
| Menkes et al. (1999) | RF TMS | 33.3 | No | No | 100% MT | 0.5 | 40 | 5 | 800 | 8 | Included 6 healthy controls who had no change in HRSD score(mean 0.7). |
| Pridmore (1999) | LDLPFC rTMS | 57 | Yes | No | 90–100% MT | 10 | 5 | 20 | 1000 | 10–14 | All 12 patients were dexamethasone test (DST) non-suppressors at baseline. 6 Of 12 normalized the DST after rTMS. These 6 had strong clinical improvement (MADRS decreased from 31 to 9; 70.0%)and maintained their response for at least 4 wk. The remaining 6 patients showed at best moderate improvement that was not sustained. |
| Pridmore et al. (1999) | LDLPFC rTMS | 52.5 | Yes | 5/24 | 90-100% MT | 10 | 5 | 25 | 1250 | 12–14 | Patients were characterized as melancholic by CORE criteria. Only 3 went on to receive ECT. In 19 of 24 episodes (79.2%) MADRS scores decreased by < 50%. The mean time from treatment to relapes was 20 wk. |
| Triggs et al. (1999) | LDLPFC rTMS | 52.0 | 9/10 | Yes | 80% MT | 20 | 2 | 40 | 2000 | 10 | 5/10 had at least 50% redution in HRSD. Motor-evoked potnetial threshold decreased during treatment in 9/10. |
| Eschweiler et al.(2000) | LDLPFC RTMS (n = 2) RDLPFC TMS (n = 2) |
50.0 | Unknown | Unknown | LDLPFC: 90–100% MT; RDLPFC: 130% MT |
LDLPFC 10%; RDLPFC: 1 |
LDLPFC: 5–6.5; RDLPFC: 50 |
LDLPFC: 20; RLDPFC: 20 |
LDLPFC: 1000–1300; RLDPFC: 1000 |
5–15 | 38% of patients were responders with CGI score indicating much or very much improved. Non-responters and patients who relapsed received RUL ECT after an average of 14.3 ± 153 d;12 of 16 responded to ECT. The inclued all 6 TMS responders. The 4 ECT non-responders did not respond to earlier TMS (p < 0.05). |
| Cohen et al. (unpubl. obs.) | Bilateral TMS: LDLPFC rTMS and RDLPFC TMS | 45 | Yes | No | LDLPFC: 100% MT; RLDPFC: 100% MT |
LDLPFC: 20; RDLPFC 1 |
LDLPFC: 1.5; RLDPFC: 60 |
LDLPFC: 20; RLDPFC: 2 |
LDPFC: 600; RDLPFC: 120 |
5–10 | 4/10 (40%)patients showed a 50% reduction in HRSD scores, but change in CGI and self-ratings wwre slight. There was a trent for younger patients to have stronger therapeutic response. |
Burt T, Lisanby SH, Sackeim HA. Neuropsychiatric applications of transcranial magnetic stimulation: a meta analysis. International Journal of Neuropsychopharmacology 2002; 5(1):73-103; Subject to the copyright notice provided by Cambridge University Press, Reprinted with the permission of Cambridge University Press and the author (9)