Repetitive transcranial magnetic stimulation in combination with citalopram in young patients with first-episode major depressive disorder: A double-blind, randomized, sham-controlled trial

Mar 7, 2012The Australian and New Zealand journal of psychiatry

Repeated brain stimulation combined with citalopram in young people with first-time major depression: a double-blind, controlled trial

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Abstract

Active repetitive transcranial magnetic stimulation (rTMS) led to 57% of patients showing early improvement in depression within 2 weeks, compared to 29% in the sham group.

Early improvement was defined as a reduction of HAMD-17 score by 20% or more within the first 2 weeks.
No significant differences were found in long-term responder rates (46% active vs. 36% sham) or remission rates (39% active vs. 29% sham) after 4 weeks.
Active rTMS resulted in significantly lower HAMD-17 and MADRS scores at both 2 and 4 weeks compared to the sham treatment.
The active rTMS group showed faster reductions in depression scores, with significant differences in both HAMD-17 and MADRS at 2 weeks and maintained at 4 weeks.
Patients receiving active rTMS did not experience a decline in executive function and improved in certain cognitive tests.

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OBJECTIVES: To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) started with citalopram in first-episode young major depressive patients.

METHODS: In a 2-week double-blind study with a 2-week extended antidepressant phase, 60 first-episode young major depressive patients were randomly assigned to citalopram in combination with 2 weeks of either active or sham rTMS treatment. During the following 2 weeks, the patients continued only the citalopram treatment. The 17-item Hamilton depression rating scale (HAMD-17) and Montgomery-Asberg depression rating scale (MADRS) were used to assess the severity of depression. Moreover, the Wisconsin Card Sorting Test (WCST), Trail-Making Test (TMT), and Stroop Color-Word Test (SCWT) were used to assess executive function.

RESULTS: (1) There was a significantly greater number of early improvers (a reduction of HAMD-17 score ≥ 20% within the first 2 weeks) observed in the active rTMS group compared to the sham group (57% vs. 29%, χ(2)=4.667, p=0.031). (2) There was no significant difference observed in responder rates (46% vs. 36%, χ(2)=0.295, p=0.586) or in remission rates (39% vs. 29%, χ(2)=0.319, p=0.572) between the two groups at 4 weeks. (3) There was a significant difference seen in both HAMD-17 and MADRS scores between the two groups at 2 and 4 weeks. The active rTMS group showed a significantly faster score reduction compared to the sham group at 2 weeks (HAMD-17, t=13.444, p=0.001; MADRS, t=30.123, p=0.000), which was maintained at 4 weeks on both scales (HAMD-17, t=46.915, p=0.000; MADRS, t=39.996, p=0.000). (4) The patients did not deteriorate in executive performance, and even improved in categories on WCST and completed TMT faster in the active group.

CONCLUSIONS: RTMS accelerated the rapidity of the antidepressant response in first-episode young depressive patients. Our results call for future rTMS studies with larger sample sizes, high intensity of stimuli, and longer duration to draw more definitive conclusions.

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Repetitive transcranial magnetic stimulation in combination with citalopram in young patients with first-episode major depressive disorder: A double-blind, randomized, sham-controlled trial

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