Table 6. Randomized trials contrasting rTMS and ECT in major depression: patient characteristics, treatment parameter, and comments.
| Study | Age | Medication resistant |
Medication free |
Stimulus intensity |
Pulse freq.(Hz) |
Train duration (s) |
No.of trains |
Pulses per session |
Total session |
Comment |
|---|---|---|---|---|---|---|---|---|---|---|
| Grunhaus et al. (2000) | 58.4 63.6 |
5/15 10/10 |
Clonazepam 1–2 mg/d No |
90%MT 2.5 × seizure threshold and increased progressively |
10 | 2 (8 patients) 6(12 patients) |
20 | 400–1200 | 20 9.6 (range 7–14) |
Pyschotic MDD patients had a superior response to ECT than rTMS (73.3 vs.27.5% reduction in HRSD, p = 0.005). Non-psychotic patients showed comparable reduction with ECT and rTMS (44.8 vs 53.2%). The degree of symptomatic improvment in non-psychotic patients was unusual for an ECT trial |
| Pridmore et al.(2000) | 44.0 41.5 |
All All |
No No |
100%MT 504 mC |
20 | 2 | 30–35 | 1200–1400 30 |
10–14 12.2±3.4 |
ECT was superior to rTMS in multivariate analyses across depression measures (p = 0.04), with the diffrent most market for the Beck Depression Inventory (BDI)(69.1 vs 45.5% improvment, p = 0.03). HOwever, no difference noted on change in HRSD. An equivalent number of patients in each group (11 of 16) achieved remission criteria (final HRSD < 8). |
| Grunhaus et al. (unpubl. obs.) | 57.6 61.4 |
na na |
Lorazepam (up to 3 mg/d) Lorazepam (up to 3 mg/d) |
90% MT 2.5 × seizure threshold and increased progressively |
10 | 6 | 10 | 1200 | 20 10.3 ± 3.1 (range 4–13) |
ECT and rTMS were equivalent in efficacy in all deoression measures. 12 of 20 ECT patients met response critiria (52% descrease in HRSD or a final rating < 10 and final GAF < 60; 11 of 20 rTMS patients met response criteria. As in the previous study by Grunhaus et al.(2000) the degree of impronement was unusually ioe for an ECT sample. |
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)