Transcranial magnetic stimulation for depression

For the first time in a large-scale study, transcranial magnetic stimulation has been shown to be an effective, non-drug treatment for major depression.

Current antidepressant therapies are not beneficial for at least a third of depressed individuals, leaving many with a lack of adequate treatment options. This study will be published in the December 1st issue of Biological Psychiatry .

Co-author Dr. Philip Janicak, professor of Psychiatry at Rush University Medical Center, says the treatment may be an option for patients with major depression who have not responded to conventional antidepressant medications.

Transcranial magnetic stimulation (TMS), a non-invasive technique that excites neurons in the brain by magnetic pulses introduced through the scalp, has previously been identified as a potential new treatment for depression but prior, smaller studies have shown conflicting results.

The authors present the results from the first large scale, multi-center, double-blind, sham-controlled study of TMS as a treatment for people with depression who had not responded to prior antidepressants and who were not taking antidepressant medications during the study. After four to six weeks of active or sham TMS, response and remission rates with active TMS were approximately twice those of sham.

This study was also associated with a low dropout rate, due to generally mild side effects, indicating that the treatment was well-tolerated by patients.

Dr. John P. O'Reardon, the corresponding author on this project and associate professor of Psychiatry at the University of Pennsylvania, explains, "These results indicate that TMS provides a novel and attractive treatment option for patients with major depression who have not responded to conventional antidepressant medications.”

Dr. John H. Krystal, editor of Biological Psychiatry, highlights the significance of this article's findings. “This study provides new support for the efficacy of TMS as a ‘stand alone' treatment for depression. This finding could be particularly important for patients who do not tolerate antidepressant medications, for whom they are not safe, or who have not benefited from other alternative treatments.”

O'Reardon adds, “As indicated by recent large scale, government-sponsored, studies of existing treatment options for major depression conducted by the National Institute of Health (the STAR-D reports), there is a great need to develop new effective treatments for patients, especially those not benefiting from first line interventions. The results of this study indicate that TMS offers new hope to patients in this regard.”

The article is “Efficacy and Safety of Transcranial Magnetic Stimulation in the Acute Treatment of Major Depression: A Multisite Randomized Controlled Trial” by John P. O'Reardon, H. Brent Solvason, Philip G. Janicak, Shirlene Sampson, Keith E. Isenberg, Ziad Nahas, William M. McDonald, David Avery, Paul B. Fitzgerald, Colleen Loo, Mark A. Demitrack, Mark S. George and Harold A. Sackeim.

The article appears in Biological Psychiatry , Volume 62, Issue 11 (December 1, 2007), published by Elsevier.

The full listing of the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) reports is available through the National Institutes of Health clinical trials website, www.ClinicalTrials.gov. The direct link is available here: http://www.clinicaltrials.gov/ct/show/NCT00021528?order=1.