Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS).
BACKGROUND Controverted results have been obtained using high frequency transcranial magnetic stimulation (HF-rTMS) as an antidepressant treatment. METHODS Forty patients suffering from drug-resistant major depression received ten sessions of HF-rTMS at 90% of the motor threshold on the left prefrontal cortex or sham stimulation, added to their pharmacological treatment, in a randomized double-blind design. In a second open phase, patients still fulfilling criteria of inclusion received ten additional sessions of HF-rTMS at 90 or 110%. RESULTS Real, but not sham HF-rTMS, was associated with a significant decrease in the Hamilton Depression Rating Scale, but only twelve patients decreased more than 50%. CONCLUSIONS Left prefrontal HF-rTMS was effectively associated with antidepressant treatment, although the size effect was small. LIMITATIONS Shortage of the sample and control difficulties of the placebo effect. CLINICAL RELEVANCE Questionable in more than half of the patients studied.