Antidepressant nonresponders may benefit from repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation (rTMS) demonstrates greater reduction in depressive symptoms than switching of antidepressant medications in patients with moderately treatment-resistant depression, reveals a study.

Eighty-nine patients with unipolar nonpsychotic depression who had an inadequate response to at least two treatment trials were randomly assigned to treatment with rTMS or to switch antidepressants. Both strategies were done in combination with psychotherapy.

The treatment lasted for a total of 8 weeks and consisted of either 25 high-frequency rTMS sessions to the left dorsolateral prefrontal cortex or a switch of antidepressant medication following the Dutch treatment algorithm.

The authors assessed the change in depression severity, the primary outcome, based on the Hamilton Depression Rating Scale (HAM-D). They also evaluated the secondary outcomes, including response and remission rates, as well as the change in symptom dimensions (ie, anhedonia, anxiety, sleep, rumination, and cognitive reactivity). Treatment expectations were also assessed.

Patients treated with rTMS showed a significantly larger reduction in depressive symptoms than those who switched to other antidepressants. The rTMS group also demonstrated higher response (37.5 percent vs 14.6 percent) and remission rates (27.1 percent vs 4.9 percent).

Moreover, patients treated with rTMS experienced greater reductions in symptoms of anxiety and anhedonia than those who switched medications. No between-group difference was noted for symptom reductions in rumination, cognitive reactivity, and sleep disorders.

“Expectations regarding treatment correlated with changes in HAM-D scores,” the authors said. 

“In addition, the findings suggest that the choice of treatment may be guided by specific symptom dimensions,” they noted.