Psychological Medicine

Original Articles

A randomized controlled trial with 4-month follow-up of adjunctive repetitive transcranial magnetic stimulation of the left prefrontal cortex for depression

A. Mogga1, G. Plucka1, S. V. Erantia1, S. Landaua2, R. Purvisa1, R. G. Browna3, V. Curtisa4, R. Howarda1, M. Philpota5 and D. M. McLoughlina1 c1

a1 Section of Old Age Psychiatry, Institute of Psychiatry, King's College London, London, UK

a2 Department of Biostatistics and Computing, Institute of Psychiatry, King's College London, London, UK

a3 Department of Psychology, Institute of Psychiatry, King's College London, London, UK

a4 Department of Psychiatry, Institute of Psychiatry, King's College London, London, UK

a5 South London and Maudsley NHS Foundation Trust, London, UK

Abstract

Background Effectiveness of repetitive transcranial magnetic stimulation (rTMS) for major depression is unclear. The authors performed a randomized controlled trial comparing real and sham adjunctive rTMS with 4-month follow-up.

Method Fifty-nine patients with major depression were randomly assigned to a 10-day course of either real (n=29) or sham (n=30) rTMS of the left dorsolateral prefrontal cortex (DLPFC). Primary outcome measures were the 17-item Hamilton Depression Rating Scale (HAMD) and proportions of patients meeting criteria for response (50% reduction in HAMD) and remission (HAMD8) after treatment. Secondary outcomes included mood self-ratings on Beck Depression Inventory-II and visual analogue mood scales, Brief Psychiatric Rating Scale (BPRS) score, and both self-reported and observer-rated cognitive changes. Patients had 6-week and 4-month follow-ups.

Results Overall, Hamilton Depression Rating Scale (HAMD) scores were modestly reduced in both groups but with no significant group×time interaction (p=0.09) or group main effect (p=0.85); the mean difference in HAMD change scores was −0.3 (95% CI −3.4 to 2.8). At end-of-treatment time-point, 32% of the real group were responders compared with 10% of the sham group (p=0.06); 25% of the real group met the remission criterion compared with 10% of the sham group (p=0.2); the mean difference in HAMD change scores was 2.9 (95% CI −0.7 to 6.5). There were no significant differences between the two groups on any secondary outcome measures. Blinding was difficult to maintain for both patients and raters.

Conclusions Adjunctive rTMS of the left DLPFC could not be shown to be more effective than sham rTMS for treating depression.

(Received April 29 2007)

(Revised July 24 2007)

(Accepted August 03 2007)

(Online publication October 15 2007)

Correspondence

c1 Address for correspondence: Dr D. M. McLoughlin, Section of Old Age Psychiatry, Box PO70, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: d.mcloughlin@iop.kcl.ac.uk)

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