Repetitive Transcranial Magnetic Stimulation in the Treatment of Depressive Disorder –  a Randomized, Single‑blind, Antidepressants‑ controlled Study

Authors: L. Ustohal;  H. Přikrylová Kučerová;  R. Přikryl;  I. Stehnová;  V. Hublová;  M. Mayerová;  S. Venclíková;  E. Češková;  T. Kašpárek
Authors‘ workplace: Psychiatrická klinika LF MU a FN Brno ;  CEITEC – Středoevropský technologický institut MU, Brno
Published in: Cesk Slov Neurol N 2014; 77/110(5): 602-607
Category: Original Paper

Tato práce vznikla díky projektu „CEITEC – Středoevropského technologického institutu“ (CZ.1.05/1.1.00/02.0068) z Evropského regionálního rozvojového fondu, výzkumnému projektu MŠMT ČR (číslo projektu 0021622404) a projektu (Ministerstva zdravotnictví) koncep­čního rozvoje výzkumné organizace 65269705 (FN Brno).


The aim of our randomized, single‑blind study was to assess the efficacy of high‑frequency repetitive transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in comparison with common antidepressants of the third or fourth generation in patients with depressive disorder.

Forty patients dia­gnosed with a depressive episode or recurrent depressive disorder were included in the study. They were randomised into two groups. One group was treated after one‑week wash‑ out period with stimulation, the other with antidepressants. Every patient was rated before and after the treatment using Hamilton depression rating scale (HAMD) and Montgomery Äsberg depression rating scale (MADRS). The stimulation was administered over the left dorsolateral prefrontal cortex, the stimulation frequency was 15 Hz, the intensity was 110% of resting motor threshold, the whole number of pulses during one session was 1,500 and the number of sessions was 15. Patients in a control group were treated with antidepressants.

In the stimulation group, the psychopathology score decreased statistically significantly (p = 0.001) on both scales (HAMD: from 21.15 ± 3.63 to 9.05 ± 3.76; MADRS: from 28.95 ± 4.25 to 13.00 ± 4.89). The psychopathology score in the control group of patients treated with antidepressants also decreased statistically significantly (p = 0.001) on both scales (HAMD: from 21.05 ± 2.79 to 9.55 ± 3.24; MADRS from 29.70 ± 3.92 to 13.55 ± 3.93). The difference between both groups was not statistically significant. There were 14 responders in the stimulation group and 13 responders in the control group.

Our study confirmed that repetitive transcranial magnetic stimulation was effective in the treatment of depressive disorder and this effect was not inferior to the effect of common antidepressants.

Key words:
repetitive transcranial magnetic stimulation – depressive disorder – treatment – psychopathology

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Loo C. TMS in the treatment of major depressive disorder. In: Wassermann EM, Epstein CM, Ziemann U(eds). The Oxford handbook of transcranial stimulation. New York: Oxford University Press 2008: 633– 660.

2. Müller MB, Toschi N, Kresse AE, Post A, Keck ME. Long‑term repetitive transcranial magnetic stimulation increases the expression of brain‑derived neurotrophic factor and cholecystokinin mRNA, but not neuropeptide tyrosine mRNA in specific areas of rat brain. Neuropsychopharmacology 2000; 23(2): 205– 215.

3. Post A, Müller MB, Engelmann M, Keck ME. Repetitive transcranial magnetic stimulation in rats: evidence for a neuroprotective effect in vitro and in vivo. Eur J Neurosci 1999; 11(9): 3247– 3254.

4. Funamizu H, Ogiue‑ Ikeda M, Mukai H, Kawato S, Ueno S. Acute repetitive transcranial magnetic stimulation reactivates dopaminergic system in lesion rats. Neurosci Lett 2005; 383(1– 2): 77– 81.

5. Kimbrell TA, Little JT, Dunn RT, Frye MA, Greenberg BD, Wassermann EM et al. Frequency dependence of antidepressant response to left prefrontal repetitive transcranial magnetic stimulation (rTMS) as a function of baseline cerebral glucose metabolism. Biol Psychiatry 1999; 46(12): 1603– 1613.

6. Speer AM, Kimbrell TA, Wassermann EM, D Repella J,Willis MW, Herscovitch P et al. Opposite effects of high and low frequency rTMS on regional brain aktivity in depressed patients. Biol Psychiatry 2000; 48(12): 1133– 1141.

7. Ustohal L. Repetitivní transkraniální magnetická stimulace (rTMS) v léčbě deprese. Psychiatr Prax 2010; 11(5– 6): 173– 177.

8. Dell’Osso B, Camuri G, Castellano F, Vecchi V, Benedetti M, Bortolussi et al. Meta‑review of metanalytic studies with repetitive transcranial magnetic stimulation (rTMS) for the treatment of major depression. Clin Pract Epidemiol Ment Health 2011; 7: 167– 177. doi: 10.2174/ 1745017901107010167.

9. Chen R, Classen J, Gerloff C, Celnik P, Wassermann EM,Hallett M et al. Depression of motor cortex excitability by low‑ frequency transcranial magnetic stimulation. Neurology 1997; 48(5): 1398– 1403.

10. Hamilton M. A rating scale for depression. J Neurol Neurosur Ps 1960; 23: 56– 62.

11. Montgomery SA, Asberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382– 389.

12. Lam RW, Mok H. Depression. New York: Oxford University Press 2008.

13. Keller MB. Issues in Treatment‑ Resistant Depression. J Clin Psychiatry 2005; 66 (Suppl 8): 5– 12.

14. Schutter DJLG. Antidepressant efficacy of high‑frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double‑blind sham‑ controlled designs: a meta‑analysis. Psychol Med 2009; 39(1): 65– 75. doi: 10.1017/  S0033291708003462.

15. Daskalakis ZJ, Levinson AJ, Fitzgerald PB. Repetitive transcranial magnetic stimulation for major depressive disorder: a review. Can J Psychiatry 2008; 53(9): 555– 566.

16. Loo CK, Sachdev PS, Haindl W, Wen W, Mitchell PB, Croker VM et al. High (15 Hz) and low (1 Hz) frequency transcranial magnetic stimulation have different acute effects on regional blood flow in depressed patients. Psychol Med 2003; 33(6): 997– 1006.

17. Fregni F, Marcolin MA, Myczkowski M, Amiaz R, Hasey G, Rumi DO et al. Predictors of antidepressant response in clinical trials of transcranial magnetic stimulation. Int J Neuropsychopharmacol 2006; 9(6): 641– 654.

18. Bares M, Kopecek M, Novak T, Stopkova P, Sos P, Kozeny J et al. Low frequency (1– Hz), right prefrontal repetitive transcranial magnetic stimulation (rTMS) compared with venlafaxine ER in the treatment of resistant depression: a double‑blind, single‑centre, randomized study. J Affect Disord 2009; 118(1– 3): 94– 100. doi: 10.1016/ j.jad.2009.01.032.

19. Chistyakov AV, Kaplan B, Rubichek O, Kreinin I, Koren D, Feinsod M et al. Antidepressant effects of different schedules of repetitive transcranial magnetic stimulation vs. clomipramine in patients with major depression: relationship to changes in cortical excitability. Int J Neuropsychopharmacol 2005; 8(2): 223– 233.

20. Fregni F, Santos CM, Myczkowski ML, Rigolino R, Gallucci‑ Neto J, Barbosa ER et al. Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004; 75(8): 1171– 1174.

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