ECT may beat rTMS for severe depression.
Previous studies have suggested that repetitive transcranial magnetic stimulation (rTMS) might be as effective as electroconvulsive therapy (ECT), while sparing patients some of the cognitive side effects. However, in the current study, rTMS did not produce the same degree of improvement overall and helped fewer patients.
In the study, the patients were drawn from a group referred for ECT for a severe major depressive episode. Twenty-two patients were randomly assigned to receive ECT and 24 patients to rTMS of the left dorsolateral prefrontal cortex. Patients who got the magnetic stimulation were assigned to receive 15 daily treatments, while the ECT took place twice weekly until the patients were deemed to have a response (Am. J. Psychiatry 2007;164:73-81).
Five patients who were having magnetic stimulation dropped out of the study before completing their treatments because they felt they were not improving, and one could not attend the 15th session. None dropped out of the ECT group.
At the end of treatment, when subjects with psychosis were excluded, 13 of the 19 remaining patients in the ECT group met the remission criterion on the 17-item Hamilton Depression Rating Scale. Four patients in the magnetic stimulation group met remission criteria, reported Dr. Savitha Eranti of the Institute of Psychiatry, King's College London, and colleagues.
Thirteen of the remaining patients who received ECT responded to treatment, compared with four of the remaining patients in the rTMS group. At 6 months' follow-up, 6 of the 12 ECT patients who achieved remission remained in remission, versus 2 of 4 patients in the rTMS group.