Does rTMS Hasten the Response to Escitalopram, Sertraline, or Venlafaxine in Patients With Major Depressive Disorder? A Double-Blind, Randomized, Sham-Controlled Trial
J Clin Psychiatry 2005;66(12):1569-1575
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transcranial magnetic stimulation (rTMS) has been mainly studied as adjunctive treatment for
drug-resistant patients. We assessed the
effectiveness of rTMS started concomitantly with
antidepressant medications in non-drug-resistant major
depressive disorder patients. We also evaluated
if, among the 3 antidepressants administered, one had a better synergy with rTMS.
Method: In this 5-week, double-blind,
randomized, sham-controlled study, we recruited 99 inpatients suffering from a major depressive
episode (DSM-IV criteria). They were randomly assigned to receive venlafaxine, sertraline,
or escitalopram in combination with a 2-week
period of sham or active 15-Hz rTMS on the left
dorsolateral prefrontal cortex. Data were gathered
from February 2004 to June 2005.
Results: The active rTMS group showed
a significantly faster reduction in Hamilton
Rating Scale for Depression (HAM-D) scores
compared with the sham group (p = .0029). The response
and remission rates were significantly greater in
the active rTMS group after the stimulation period (p = .002 and p = .003, respectively), but not at
the endpoint. We found no significant difference
in HAM-D score reduction among the 3 drugs administered, either in the active or in the
Conclusion: These findings support the
efficacy of rTMS in hastening the response to
antidepressant drugs in patients with major
depressive disorder. The effect of rTMS seems to be
unaffected by the specific concomitantly