A Randomized, Controlled Trial With 6-Month Follow-Up of Repetitive Transcranial Magnetic Stimulation and Electroconvulsive Therapy for Severe Depression

Abstract

Objective: Repetitive transcranial magnetic stimulation (rTMS) has been reported to be as effective as electroconvulsive therapy (ECT) for major depression. The authors conducted a multicenter randomized, controlled trial to test the equivalence of rTMS with ECT. Method:Forty-six patients with major depression referred for ECT were randomly assigned to either a 15-day course of rTMS of the left dorsolateral prefrontal cortex (N=24) or a standard course of ECT (N=22). The primary outcome measures were the score on the 17-item Hamilton Depression Rating Scale (HAM-D) and the proportion of patients with remissions (Hamilton score, ≤8) at the end of treatment. Secondary outcomes included mood self-ratings on the Beck Depression Inventory-II and visual analogue mood scales, Brief Psychiatric Rating Scale (BPRS) score, and both self-reported and observer-rated cognitive changes. The patients were followed up after 6 months.Results: HAM-D scores at the end of treatment were significantly lower for ECT, with 13 patients (59.1%) achieving remission in the ECT group and four (16.7%) in the rTMS group. However, at 6 months the HAM-D scores did not differ between groups. Beck scale, visual analogue mood scale, and BPRS scores were lower for ECT at the end of treatment and remained lower after 6 months. Self-and observerrated cognitive measures were similar in the two groups.Conclusions: rTMS was not as effective as ECT, and ECT was substantially more effective for the short-term treatment of depression.

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

“…Electroconvulsive therapy (ECT) is a highly effective acute treatment for major depression (Eranti et al, 2007;Kellner et al, 2010;The UK ECT Review Group, 2003). Although remission rates exceed those seen with other somatic treatments, high rates of relapse, especially early relapse, are observed and acknowledged as a major clinical problem (Kellner et al, 2006;Sackeim et al, 2001).…”

“…Most experimental work over the past 3 decades has focused primarily on optimizing ECT treatment parameters (eg, electrode placement, stimulus dose, and pulse width) to produce the best possible balance between clinical and neuropsychological outcomes. These studies unequivocally show that ECT is a powerful treatment option capable of producing full remission where other treatments have failed (Dunne and McLoughlin, 2012;Eranti et al, 2007;Kellner et al, 2010;Loo et al, 2012;Sackeim et al, 2009). However, given that relapse following ECT is a key clinical problem, we carried out a systematic review of all existing evidence, randomized and observational, to provide an overview of current knowledge on this important question.…”

Terapias somáticas para transtornos psiquiátricos resistentes ao tratamento

“…In a more recent multi-center, controlled trial, 46 patients were randomized to ECT versus rTMS. 21 Despite relatively low dose right unilateral ECT and small number of ECT treatments (mean of 6.3), ECT was markedly superior to rTMS. While 59.1% of patients who received ECT remitted, remission rates were only 16.7% in patients treated with rTMS.…”

Epigenetics and depression: return of the repressed

“…Suicide completers with MDD Global ↓and reorganisation in miRNA expression in MDD ↓21 miRNAs Uddin et al (2011) Blood MDD Altered DNA methylation pattern in MDD Xu et al (2010) Blood MDD Polymorphism in pre-miR30e associated with MDD and difficulties with the speed of perception and processing of auditory stimuli (Eranti et al, 2007;UK Ect Review Group, 2003). The precise mechanisms of action of ECT remain unknown but evidence in animal models suggests that treatment with ECS (electroconvulsive stimulation), the animal model equivalent of ECT, results in epigenetic modification of gene expression (Table 3).…”