The Combination of Antidepressant Drug Therapy and High-Frequency Repetitive Transcranial Magnetic Stimulation in Medication-Resistant Depression

The combination of antidepressant drug therapy and high-frequency repetitive transcranial magnetic stimulation in medication-resistant depression Objective: The optimal treatment parameters for repetitive transcranial magnetic stimulation (rTMS) are not yet determined. The aim of this study was to investigate the efficacy of rTMS at two different intensities as an add-on treatment to antidepressants in medication-resistant depression. Methods: In this randomized, double-blind, sham-controlled trial, 35 outpatients were randomly assigned to rTMS with an intensity of 80% or 110% of motor threshold at 20 Hz over the left dorsolateral prefrontal cortex or to sham rTMS for 6 weeks in addition to antidepressant medications. Patients were assessed using the Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale prior to the treatment and weekly during treatment. Results: A more than 50% decrease in the mean scores of the two scales from baseline was achieved in both active rTMS groups. This significant change in scores over time was more prominent between weeks 4-6 of the active treatment. No difference was found between the 110% and 80% rTMS groups regarding scale scores and response/remission rates. rTMS treatment was well tolerated without any major adverse event. Conclusions: rTMS with an intensity of 80% or 110% of resting motor threshold could augment antidepressant effects in medication-resistant depression especially during 4-6 weeks of active treatment.