Pharmacopsychiatry 2008; 41(2): 41-47
DOI: 10.1055/s-2007-993210
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Repetitive Transcranial Magnetic Stimulation (rTMS) in Combination with Escitalopram in Patients with Treatment-Resistant Major Depression. A Double-Blind, Randomised, Sham-Controlled Trial

L. G. Bretlau 1 , M. Lunde 1 , L. Lindberg 1 , M. Undén 1 , S. Dissing 2 , P. Bech 1
  • 1Psychiatric Research Unit, Frederiksborg General Hospital, Hillerød, Denmark
  • 2Department of Cellular and Molecular Medicine, Panum Institute, University of Copenhagen, Copenhagen N, Denmark
Further Information

Publication History

received 23.10.2006 revised 05.05.2007

accepted 05.10.2007

Publication Date:
29 February 2008 (online)

Abstract

Background: The role of high-frequency rTMS over the left cortex as an add-on strategy in the treatment of major depression is still uncertain even in patients resistant to pharmacotherapy. We had planned a large sham TMS controlled study in the acute phase with a placebo-controlled relapse-prevention phase with escitalopram. However, because a recent meta-analysis showed only a small effect size of rTMS over sham TMS in the acute treatment phase of depressed patients, we decided to make an interim analysis.

Method: In patients with medication-resistant major depression we administered in a randomised trial 15 sessions of sham-controlled rTMS over three weeks in combination with 20 mg escitalopram daily. After the last rTMS, the patients were followed for another 9 weeks on 20 mg escitalopram daily. The antidepressant effect was measured by the HAM-D6 as primary outcome scale.

Results: A total of 45 patients with complete data were randomised so that 23 patients received sham TMS and 22 patients received active, high-frequency rTMS over the left cortex. Over the 3 weeks, the active rTMS treatment was superior to sham TMS with effect sizes on the HAM-D6 above 0.70, which indicates not only a statistically but also a clinically significant effect. The patients had typically been through two failed antidepressant treatment attempts with non-tricyclics before inclusion in the study. Both the rTMS and escitalopram were well-tolerated.

Conclusion: High-frequency rTMS over the left cortex is an add-on strategy of clinical significance in combination with escitalopram in patients with major depression resistant to non-tricyclic antidepressants.

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Correspondence

P. BechMD 

Frederiksborg General Hospital

Dyrehavevej 48

DK-3400 Hillerød

Denmark

Phone: +45/4829 32 53

Fax: +45/4826 33 77

Email: pebe@noh.regionh.dk

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