Repetitive transcranial magnetic stimulation is not as effective as electroconvulsive therapy for major depression.

摘要

Treatment resistant depression (TRD) remains a substantive clinical problem with few therapeutic alternatives oiher than ECT, which remains unacceptable or unavailable to many patients. Studies are actively exploring repetitive - franscranial magnetic stimulation (rTMS) techniques for depression and this randomised trial compared' the effectiveness of high frequency ieft-sfded prefronta! rTMS to ECT (unilateral or bilateral). This study follows a series of similar randomised ECTjTMS comparisons, Grunhaus ef a/being an example,1 as well as a large number of studies comparing rTMS techniques to sham stimulation. There is considerable debate as to the appropriate comparator for rTMS. Some believe this is ECT while others holdthe view that rTMS is more likely to be offered to patients who are perhaps not as acutely unwell as those traditionally provided ECT, tut suffer persistent ,TRD and currently receive recurrent and multiple-.unsuccessful trials of anttdepressant medication and augmentation.The main.tondusion of mis study was that rTMS was not as effective as ECT in the short-term treatment of.depression. Unfortunately the authors compared a flexible regime of unfixed duration of unilateral or bilateral ECT to a relatively short and fixed duration of unilateral rTMS. Recent research suggests that longer periods of rTMS and potentially other stimulation parameters may be as or.more effective than that used as the rTMS condition here-for"example," sequential bilateral stimulation.2 In addition, the agegroup in this study was "quite old and as rTMS effects may be less in the elderly or require dose adjustment, "mis limits capacity to generalise this finding to adult populations. There is clearly insufficient evidence to support replacing ECT with rTMS at this stage. -On the other hand, this study does not exclude rTMS as a viable treatment alternative and further research is required including with mope flexible rTMS conditions.