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Title: Exploring alternative rTMS strategies in non-responders to standard high frequency left-sided treatment: A switching study.
Epworth Authors: Fitzgerald, Paul
Other Authors: Hoy, Kate
Elliot, David
McQueen, Susan
Wambeek, Lenore
Daskalakis, Zafiris
Keywords: Repetitive Transcranial Magnetic Stimulation
High-Frequency Left-Sided rTMS
Low-Frequency Right-Sided rTMS
Sequential Bilateral rTMS
Antidepressant Response
Depressive Symptoms
Montgomery Asberg Depression Rating Scale
Hamilton Depression Rating Scale scores.
Rehabilitation, Mental Health and Chronic Pain Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: May-2018
Publisher: Elsevier
Citation: J Affect Disord. 2018 May;232:79-82
Abstract: BACKGROUND: High-frequency left-sided repetitive transcranial magnetic stimulation (rTMS) is now commonly used treatment for patients with depression. However, there are several other forms of rTMS (low-frequency right-sided and sequential bilateral rTMS) which have also been shown to be effective. No information has been systematically gathered on the likelihood of response to alternative forms of rTMS in patients who do not improve after an initial course of left-sided treatment. OBJECTIVE: To evaluate whether there are differences in antidepressant response between switching to either low-frequency right sided or sequential bilateral stimulation or continuing high-frequency left-sided TMS following non-response to an initial course of high-frequency left-sided rTMS. METHODS: 113 rTMS naïve patients were provided with an initial three-week course of high-frequency left-sided rTMS. Non-responders were then randomised to receive another three weeks of left-sided treatment (n = 21), right-sided low frequency stimulation (n = 18) or sequential bilateral rTMS (n = 20). RESULTS: Although there was an overall improvement in depressive symptoms in the randomised phase of the study, no significant differences in response was seen between the three treatment groups on Montgomery Asberg Depression Rating Scale or Hamilton Depression Rating Scale scores. LIMITATIONS: The main limitation of the study was the duration of treatment provided in both the lead in and random treatment phases. CONCLUSION: This study does not provide evidence for differences in response to different forms of rTMS in initial non-responders to left-sided stimulation. However, further studies with longer periods of treatment and a larger sample size are required to definitively establish or exclude between group differences in rTMS response in initial non-responders to treatment.
DOI: 10.1016/j.jad.2018.02.016
PubMed URL:
ISSN: 0165-0327
Journal Title: Journal of Affective Disorders
Type: Journal Article
Affiliated Organisations: Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Victoria, Australia
Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Ontario, Canada.
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:Mental Health
Research Month

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