Brain Stimulation Reverses Depression in Some

Daily repetitive transcranial magnetic stimulation (TMS) to the left prefrontal lobe was more effective than placebo in inducing remission from major depression.

This was a key finding published in the May Archives of General Psychiatry, which reported the acute-phase results of the Optimization of TMS for Depression Trial (OPT-TMS).

When in the acute phase, 190 patients with major depressive disorder were randomly assigned to active or sham TMS treatment five days a week for three weeks. At the end of the three weeks, patients who achieved remission were tapered off and placed on medications, although those who had sufficient improvement but no remission continued with the assigned treatment for up to another three weeks. Patients without sufficient improvement were switched to an unblinded treatment phase of the study that lasted for up to six weeks.

All patients remained free of antidepressant, antipsychotic, or antiepileptic medications for two weeks before the treatment started and during the study treatment.

Sufficient improvement was defined as at least a 30 percent reduction in Hamilton Depression Rating Scale (HAM-D) score from baseline. Remission was defined as having a HAM-D score of 3 or less in one assessment or two consecutive HAM-D scores of less than 10. Patients were administered the HAM-D twice a week by independent raters who were not involved in providing the TMS treatment.

During this acute phase, 18 patients achieved remission, eight of whom did so in the first three weeks of treatment; six of those eight patients had active TMS and two had sham treatment. Ten other patients achieved remission during weeks 4 to 6, including seven who had active TMS and three who had sham TMS.

Based on an intent-to-treat analysis, 14 percent of patients in the active TMS treatment arm (n=92) met the remission criteria. This was significantly higher than the 5 percent remission rate in the sham treatment arm (n=98). The number needed to treat was 12.

Among the 144 patients who did not show sufficient improvement in the first three weeks and were switched to the open-label treatment phase, 43 (30 percent) met the remission criteria during the open treatment.

The treatment was well tolerated, the researchers noted, and the rate of adverse events did not differ between active TMS and sham treatment groups. No seizure or suicidal events occurred. Headache was the most common adverse event, reported by 32 percent of patients on active TMS and 23 percent on sham treatment.