rTMS shows promise for treating vascular depression.(rTMS Update)

In what are believed to be the first randomized, controlled trials on the efficacy of repetitive transcranial magnetic stimulation rTMS) to treat vascular depression (VD), investigators showed significantly greater reductions of scores on the 17-item Hamilton Depression Rating Scale (HAMD-17) among patients receiving active instead of sham treatment. The second phase of the trial (experiment 2) also showed significantly greater response and remission rates among those receiving active rTMS.

The study, led by Ricardo E. Jorge. M.D., of the University of Iowa, was published in the March 2008 Archives of General Psychiatry.

Background

VD refers to late-life depressive disorders in patients with evidence of cerebrovascular disease. It has been estimated that about 54% of late-life depressive disorders meet the criteria for VD. Some studies have suggested that VD is more chronic and difficult to treat than early-onset depression.

There have been an increasing number of articles over the past few years on the efficacy of rTMS, but few studies of older patients exist, and almost none on patients with coexisting cerebrovascular disease. However, a small randomized doubleblind study of patients with poststroke depression comparing active and sham left prefrontal rTMS found a significant reduction of depressive symptoms with active rTMS. In addition, the only known study that examined rTMS response in VD (an open study of 11 patients with late-onset treatment-resistant VD) showed that 5 of 11 patients were treatment responders.

The present study authors hypothesized that active left prefrontal rTMS would be associated with a significantly greater reduction of depressive symptoms and increased response and remission rates among patients with clinically defined VD, compared to patients receiving sham rTMS.

Study methodology