Transcranial magnetic stimulation in the acute treatment of major depressive disorder: Clinical response in an open-label extension trial

David H. Avery, Keith E. Isenberg, Shirlene M. Sampson, Philip G. Janicak, Sarah H. Lisanby, Daniel F. Maixner, Colleen Loo, Michael E. Thase, Mark A. Demitrack, Mark S. George

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Abstract

Background: This report describes the results of an open-label extension study of active transcranial magnetic stimulation (TMS) in medication-resistant patients with major depressive disorder who did not benefit from an initial course of therapy in a previously reported 6-week, randomized controlled study of active versus sham TMS. Method: Patients with DSM-IV-defined major depressive disorder were actively enrolled in the study from February 2004 through September 2005 and treated with left prefrontal TMS administered 5 times per week at 10 pulses per second, at 120% of motor threshold, for a total of 3000 pulses/session. The primary outcome was the baseline to endpoint change score on the Montgomery-Asberg Depression Rating Scale (MADRS). Results: In those patients who received sham in the preceding randomized controlled trial (N = 85), the mean reduction in MADRS scores after 6 weeks of open-label active TMS was -17.0 (95% CI = -14.0 to -19.9). Further, at 6 weeks, 36 (42.4%) of these patients achieved response on the MADRS, and 17 patients (20.0%) remitted (MADRS score < 10). For those patients who received and did not respond to active TMS in the preceding randomized controlled trial (N = 73), the mean reduction in MADRS scores was -12.5 (95% CI = -9.7 to -15.4), and response and remission rates were 26.0% and 11.0%, respectively, after 6 weeks of additional openlabel TMS treatment. Conclusions: This open-label study provides further evidence that TMS is a safe and effective treatment of major depressive disorder. Furthermore, continued active TMS provided additional benefit to some patients who failed to respond to 4 weeks of treatment, suggesting that longer courses of treatment may confer additional therapeutic benefit. Trial Registration: clinicaltrials.gov Identifier: NCT00104611.

Original languageEnglish (US)
Pages (from-to)441-451
Number of pages11
JournalJournal of Clinical Psychiatry
Volume69
Issue number3
DOIs
StatePublished - Mar 2008

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ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Avery, D. H., Isenberg, K. E., Sampson, S. M., Janicak, P. G., Lisanby, S. H., Maixner, D. F., Loo, C., Thase, M. E., Demitrack, M. A., & George, M. S. (2008). Transcranial magnetic stimulation in the acute treatment of major depressive disorder: Clinical response in an open-label extension trial. Journal of Clinical Psychiatry, 69(3), 441-451. https://doi.org/10.4088/JCP.v69n0315