PT  - JOURNAL ARTICLE
AU  - Daniel M. Blumberger
AU  - Jerome J. Maller
AU  - Lauren Thomson
AU  - Benoit H. Mulsant
AU  - Tarek K. Rajji
AU  - Missy Maher
AU  - Patrick E. Brown
AU  - Jonathan Downar
AU  - Fidel Vila-Rodriguez
AU  - Paul B. Fitzgerald
AU  - Zafiris J. Daskalakis
TI  - Unilateral and bilateral MRI-targeted repetitive transcranial magnetic stimulation for treatment-resistant depression: a randomized controlled study
AID  - 10.1503/jpn.150265
DP  - 2016 Jul 01
TA  - Journal of Psychiatry and Neuroscience
PG  - E58--E66
VI  - 41
IP  - 4
4099  - http://jpn.ca/content/41/4/E58.short
4100  - http://jpn.ca/content/41/4/E58.full
SO  - J Psychiatry Neurosci2016 Jul 01; 41
AB  - Background: Several factors may mitigate the efficacy of repetitive transcranial magnetic stimulation (rTMS) over sham rTMS in patients with treatment-resistant depression (TRD). These factors include unilateral stimulation (i.e., treatment of only the left dorsolateral prefrontal cortex [DLPFC]), suboptimal methods of targeting the DLPFC and insufficient stimulation intensity (based on coil-to-cortex distance).Methods: We recruited patients with TRD between the ages of 18 and 85 years from a university hospital, and participants were randomized to receive sequential bilateral rTMS (600 pulses at 1 Hz followed by 1500 pulses at 10 Hz), unilateral high-frequency left (HFL)-rTMS (2100 pulses at 10 Hz) or sham rTMS for 3 or 6 weeks depending on treatment response. Stimulation was targeted with MRI localization over the junction of the middle and anterior thirds of the middle frontal gyrus, using 120% of the coil-to-cortex adjusted motor threshold. Our primary outcome of interest was the remission rate.Results: A total of 121 patients participated in this study. The remission rate was significantly higher in the bilateral group than the sham group. The remission rate in the HFL-rTMS group was intermediate and did not differ statistically from the rate in the 2 other groups. There were no significant differences in reduction of depression scores among the 3 groups.Limitations: The number of pulses used per session in the unilateral group was somewhat lower in our trial than in more recent trials, and the sham condition did not involve active stimulation.Conclusion: Our findings suggest that sequential bilateral rTMS is superior to sham rTMS; however, adjusting for coil-to-cortex distance did not yield enhanced efficacy rates.