Efficacy of adjunctive high frequency repetitive transcranial magnetic stimulation of left prefrontal cortex in depression: A randomized sham controlled study

Objective: To examine the efficacy of adjunctive left prefrontal high-frequency rTMS treatment in depression patients as compared to sham stimulation. Method: 45 right handed moderate to severe depression patients according to ICD-10 DCR criteria were randomized to receive daily sessions of active or sham rTMS (10 Hz, 90% of resting MT, 20 trains, 6 s duration, 1200 pulses/day) over the right dorsolateral prefrontal cortex for 10 days. Depression and psychosis was rated using Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D) and Brief Psychiatric Rating Scale (BPRS) respectively before and after rTMS. Result: For SIGH-D scores, repeated measures ANOVA showed a significant effect of treatment over time as shown by interaction effect (Pillai's Trace F [1/38] = 56.75, p < .001, η² = .60). For BPRS, repeated measures ANOVA showed a significant interaction effect of treatment over time (Pillai's Trace F [1/38] = 39.87, p < .001, η² = .51). In psychotic depression patients, repeated measures ANOVA showed a significant effect of treatment over time for SIGH-D scores (Pillai's Trace F [1/25] = 43.04, p<.001, η² = .63) and BPRS scores (Pillai's Trace F [1/25] = 42.17, p < .001, η² = .63). Conclusion: High-frequency left prefrontal rTMS was well tolerated and found to be effective as add-on to standard pharmacotherapy in nonpsychotic as well as psychotic depression.