A 3-Month Follow-Up Randomized Placebo-Controlled Study of Repetitive Transcranial Magnetic Stimulation in Depression

Frank Koerselman M.D. Ph.D.; D. Martin Laman M.D.;Hans van Duijn M.D. Ph.D.; Marijtje A. J. van Duijn Ph.D.; and Martin A. M. Willems M.D.

Background/Objective: There is evidence for an antidepressant effect of repetitive transcranial magnetic stimulation (rTMS) but little is known about posttreatment course. Therefore we conducted a placebo-controlled double-blind study in depressed patients in order to investigate the effect of rTMS on depression over 12 weeks after completion of the 2-week stimulation period.

Method: 55 patients with a moderate or severe DSM-IV major depressive episode were randomly assigned to rTMS or sham treatment. rTMS was given daily for 10 days over the left dorsolateral prefrontal cortex with the following treatment parameters: 20 Hz 20 trains of 2 seconds 30 seconds between trains and 80% motor threshold. The effect of rTMS on depression was rated repeatedly with the 17-item Hamilton Rating Scale for Depression (HAM-D) during the 2-week period of stimulation and the 12-week follow-up period conducted from 1997 to 2001.

Results: We found a modest clinically nonrelevant decrease in HAM-D scores in both rTMS and sham patients over 2 weeks of treatment. However over the subsequent 12-week follow-up the rTMS group continued to improve significantly compared with the placebo group.

Conclusion: Decrease of depressive symptoms may continue after the cessation of rTMS stimulation.

(J Clin Psychiatry 2004;65:1323-1328)

Received Sept. 4 2003; accepted March 15 2004. From the Departments of Psychiatry (Drs. Koerselman and Willems) and Neurophysiology (Drs. Laman and H. van Duijn) St. Lucas Andreas Hospital Amsterdam; the Department of Psychiatry Rudolf Magnus Institute of Neuroscience University Medical Center Utrecht (Dr. Koerselman); and the Department of Statistics and Measurement Theory University of Groningen Groningen (Dr. M. A. J. van Duijn) the Netherlands.

The authors report no financial affiliations or other relationships relevant to the subject matter of this study.

The authors thank Ingrid L. Tensen M.D. and Judith van der Riet Ph.D. for their contributions.

Corresponding author and reprints: Frank Koerselman M.D. Ph.D. St. Lucas Andreas Hospital Department of Psychiatry PO Box 9243 1006 AE Amsterdam the Netherlands (e-mail: f.koerselman@slaz.nl).