The International Journal of Neuropsychopharmacology

Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation

Felipe Fregni a1 1 c1, Marco A. Marcolin a2 1 , Martin Myczkowski a2, Revital Amiaz a3, Gary Hasey a4, Demetrio O. Rumi a2, Moacyr Rosa a2, Sergio P. Rigonatti a2, Joan Camprodon a1, Michaela Walpoth a5, Jaclyn Heaslip a4, Leon Grunhaus a3, Armand Hausmann a5 and Alvaro Pascual-Leone a1
a1 Harvard Center for Noninvasive Brain Stimulation, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
a2 Department of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
a3 Department of Psychiatry, Tel-Aviv University, Tel-Aviv, Israel
a4 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
a5 Department of Psychiatry, Medical University Innsbruck, Innsbruck, Austria

Article author query
fregni f   [PubMed][Google Scholar] 
marcolin ma   [PubMed][Google Scholar] 
myczkowski m   [PubMed][Google Scholar] 
amiaz r   [PubMed][Google Scholar] 
hasey g   [PubMed][Google Scholar] 
rumi do   [PubMed][Google Scholar] 
rosa m   [PubMed][Google Scholar] 
rigonatti sp   [PubMed][Google Scholar] 
camprodon j   [PubMed][Google Scholar] 
walpoth m   [PubMed][Google Scholar] 
heaslip j   [PubMed][Google Scholar] 
grunhaus l   [PubMed][Google Scholar] 
hausmann a   [PubMed][Google Scholar] 
pascual-leone a   [PubMed][Google Scholar] 


Although previous clinical trials have suggested that repetitive transcranial magnetic stimulation (rTMS) has a significant antidepressant effect, the results of these trials are heterogeneous. We hypothesized that individual patients' characteristics might contribute to such heterogeneity. Our aim was to identify predictors of antidepressant response to rTMS. We pooled data from six separate clinical trials conducted independently, which evaluated the effects of rapid rTMS of the left dorsolateral prefrontal cortex in patients with major depression. We investigated 195 patients with regard to demographic, depression and treatment characteristics, psychiatric and drug history. Results showed that age and treatment refractoriness were significant negative predictors of depression improvement when adjusting these variables to other significant predictors and confounders. These findings were not confounded by methodological differences from the six studies, as the results were adjusted for the study site. In conclusion TMS antidepressant therapy in younger and less treatment-resistant patients is associated with better outcome.

(Received May 26 2005)
(Reviewed July 10 2005)
(Revised September 6 2005)
(Accepted September 13 2005)
(Published Online November 23 2005)

Key Words: Age; Hamilton Depression Rating Scale; major depression; transcranial magnetic stimulation.

c1 Harvard Center for Noninvasive Brain Stimulation, Harvard Medical School, 330 Brookline Ave, KS 452, Boston, MA 02215, USA. Tel.: (617) 667-5272 Fax: (617) 975-5322 E-mail:


1 These authors contributed equally to this work.