Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: A multisite randomized controlled trial

被引:1235
作者
O'Reardon, John P.
Solvason, H. Brent
Janicak, Philip G.
Sampson, Shirlene
Isenberg, Keith E.
Nahas, Ziad
McDonald, William M.
Avery, David
Fitzgerald, Paul B.
Loo, Colleen
Demitrack, Mark A.
George, Mark S.
Sackeim, Harold A.
机构
[1] Univ Penn, Lab Transcranial Magnet Simulat, Dept Psychiat, Philadelphia, PA 19014 USA
[2] Stanford Univ, Dept Psychiat, Palo Alto, CA 94304 USA
[3] Rush Univ, Med Ctr, Dept Psychiat, Chicago, IL 60612 USA
[4] Mayo Clin, Coll Med, Rochester, MN USA
[5] Washington Univ, Sch Med, Dept Psychiat, St Louis, MO 63110 USA
[6] Emory Univ, Dept Psychiat & Behav Sci, Atlanta, GA 30322 USA
[7] Univ Washington, Sch Med, Dept Psychiat & Behav Sci, Seattle, WA 98195 USA
[8] Monash Univ, Alfred Psychiat Res Ctr, Sch Psychol Psychiat & Psychol Med, Melbourne, Vic 3004, Australia
[9] Univ New S Wales, Sch Psychiat, Sydney, NSW, Australia
[10] Med Univ S Carolina, Dept Psychiat, Charleston, SC 29425 USA
[11] Neuronetics Inc, Malvern, PA USA
[12] Columbia Univ, New York State Psychiat Inst, Dept Biol Psychiat, New York, NY USA
[13] Columbia Univ, Coll Phys & Surg, New York, NY USA
关键词
clinical trial; efficacy; major depression; safety; TMS;
D O I
10.1016/j.biopsych.2007.01.018
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Background: We tested whether transcranial magnetic stimulation (TMS) over the left dorsolateral prefrontal cortex (DLPFC) is effective and safe in the acute treatment of major depression. Methods: In a double-blind, multisite study, 301 medication-free patients with major depression who had not benefited from prior treatment were randomized to active (n = 155) or sham TMS (n = 146) conditions. Sessions were conducted five times per week with TMS at 10 pulses/sec, 120% of motor threshold, 3000 pulses/session, for 4-6 weeks. Primary outcome was the symptom score change as assessed at week 4 with the Montgomery-Asberg Depression Rating Scale (MADRS). Secondary outcomes included changes on the 17- and 24-item Hamilton Depression Rating Scale (HAMD) and response and remission rates with the MADRS and HAMD. Results: Active TMS was significantly superior to sham TMS on the MADRS at week 4 (with a post hoc correction for inequality in symptom severity between groups at baseline), as well as on the HAMD17 and HAMD24 scales at weeks 4 and 6. Response rates were significantly higher with active TMS on all three scales at weeks 4 and 6. Remission rates were approximately twofold higher with active TMS at week 6 and significant on the MADRS and HAMD24 scales (but not the HAMD17 scale). Active TMS was well tolerated with a low dropout rate for adverse events (4.5%) that were generally mild and limited to transient scalp discomfort or pain. Conclusions: Transcranial magnetic stimulation was effective in treating major depression with minimal side effects reported. It offers clinicians a novel alternative for the treatment of this disorder.
引用
收藏
页码:1208 / 1216
页数:9
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