method appears to help induce remission in some patients with depression
magnetic stimulation—an intervention that
uses magnetic currents to activate certain brain areas—appears to help
induce remission in patients with treatment-resistant depression,
according to a report in the May issue of Archives of General
Psychiatry, one of the JAMA/Archives journals.
Major depression is common, disabling and expensive, and more effective
treatments are needed, according to background information in the
article. Some patients experience little or no improvement after
medication, psychotherapy or both. Transcranial magnetic stimulation
has shown potential as a depression treatment, but there is concern
regarding the quality of existing research.
Mark S. George, M.D., MUSC Distinguished University Professor and
director, Center for Advanced Imaging Research and S.C. Brain Imaging
Center for Excellence, and colleagues conducted a randomized controlled
trial of repetitive transcranial magnetic stimulation among 190
patients with depression who were not taking medication. Of these, 92
were randomly assigned to receive the intervention, which involved
stimulating the left prefrontal cortex with an electromagnetic coil for
37.5 minutes daily for three weeks. The other 98 received a sham
treatment that mimicked the sensory experience of stimulation using a
similar coil and scalp electrodes but with the magnetic field blocked.
A total of 90 percent of patients in the sham group and 86 percent in
the treatment group completed the study. Among these, depression
remitted in 14.1 percent in the transcranial magnetic stimulation
group, compared with 5.1 percent in the sham group. The odds of
achieving remission were 4.2 times greater in the active treatment
“One of the most important aspects of the study was ensuring that no
one who knew the randomization status of the patient ever came in
contact with the patient or interacted with the data,” the authors
write. “We developed a new active sham transcranial magnetic
stimulation system that simulated the repetitive transcranial magnetic
stimulation somatosensory experience and effectively masked the
patients, the raters and, to a large extent, the treaters.” At the end
of the treatment phase, patients, treaters and clinical raters were
asked to guess whether they were in the active or treatment group. Only
treaters were able to guess at a rate more accurate than chance, and
they were not very confident of their responses.
The researchers calculated that for every 12 patients treated with
transcranial magnetic stimulation, one would remit from depression.
Most remissions occurred among individuals with low antidepressant
“The results of this study suggest that prefrontal repetitive
transcranial magnetic stimulation is a monotherapy with few adverse
effects and significant antidepressant effects for unipolar depressed
patients who do not respond to medications or who cannot tolerate
them,” the authors conclude.
Friday, May 28, 2010