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A randomized trial of unilateral and bilateral prefrontal cortex transcranial magnetic stimulation in treatment-resistant major depression

Published online by Cambridge University Press:  07 October 2010

P. B. Fitzgerald ,
K. Hoy ,
R. Gunewardene ,
C. Slack ,
S. Ibrahim ,
M. Bailey  and
Z. J. Daskalakis
P. B. Fitzgerald*
Affiliation:
Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia The Victoria Clinic, Prahran, Victoria, Australia
K. Hoy
Affiliation:
Monash Alfred Psychiatry Research Centre, The Alfred and Monash University School of Psychology and Psychiatry, Melbourne, Victoria, Australia
R. Gunewardene
Affiliation:
Mosman Private Hospital, Mosman, New South Wales, Australia
C. Slack
Affiliation:
Pine Rivers Private Hospital, Strathpine, Queensland, Australia
S. Ibrahim
Affiliation:
Northpark Private Hospital, Bundoora, Victoria, Australia
M. Bailey
Affiliation:
Monash University Department of Epidemiology and Preventive Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
Z. J. Daskalakis
Affiliation:
Centre for Addiction and Mental Health, Clarke Division, Toronto, Ontario, Canada
*
*Address for correspondence: Professor P. B. Fitzgerald, M.B.B.S., M.P.M., Ph.D., F.R.A.N.Z.C.P., Monash Alfred Psychiatry Research Centre, First Floor, Old Baker Building, The Alfred, Commercial Rd, Melbourne, Victoria 3004, Australia. (Email: paul.fitzgerald@med.monash.edu.au)
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Abstract

Background

Although several studies have reported that repetitive transcranial magnetic stimulation (rTMS) treatment has demonstrable efficacy in patients with depression, the parameters needed to optimize therapeutic efficacy remain unclear. To this end we determined the efficacy of low-frequency right rTMS to the dorsolateral prefrontal cortex (DLPFC) compared to two forms of bilateral rTMS to the DLPFC: (1) sequential low-frequency right-sided followed by high-frequency left-sided rTMS and (2) sequential low-frequency rTMS to both hemispheres.

Method

A total of 219 patients with treatment-resistant depression (TRD) were randomized to a 4-week course of rTMS applied with one of the three treatment conditions. Outcomes were assessed with standard rating scales.

Results

Overall, slightly more than 50% of the patients achieved clinical response criteria. There was no substantial difference in response between the unilateral and bilateral treatment groups. Successful response to rTMS was predicted by a greater degree of baseline depression severity.

Conclusions

There is no substantial difference in efficacy between unilateral right-sided rTMS and the two forms of bilateral rTMS assessed in the study. Furthermore, our results call into question the specificity between frequency and laterality and rTMS response.

Keywords

Antidepressantdepressionprefrontal cortexremissionrepetitive transcranial magnetic stimulationresponse
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 6 , June 2011 , pp. 1187 - 1196
Copyright
Copyright © Cambridge University Press 2010

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