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Repetitive Transcranial Magnetic Stimulation Versus Electroconvulsive Therapy for the Treatment of Major Depressive Disorder, A Randomized Controlled Clinical Trial

Keshtkar, Mitra MD; Ghanizadeh, Ahmad MD; Firoozabadi, Ali MD

Journal of ECT:
doi: 10.1097/YCT.0b013e318221b31c
Original Studies

Introduction: Studies comparing the antidepressant effects of electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have reported mixed results. This study compared the efficacy of rTMS and ECT in adult patients with refractory major depressive disorder (MDD).

Methods: This randomized, ECT-controlled, parallel-group clinical trial analyzed the antidepressant effects of ECT and rTMS in 73 patients with MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. The Beck Depression Inventory and Hamilton Depression Rating Scale were used to measure depression.

Results: Both ECT and rTMS significantly improved depression and suicidal behavior scores. However, ECT reduced depression and suicidal behavior scores more than rTMS. There were no significant adverse effects in the rTMS group.

Discussion: Both ECT and rTMS improved MDD in the short term, but the antidepressant efficacy of ECT was greater than rTMS. Moreover, ECT led to greater reductions in suicidal behavior than rTMS. Until strong evidence for the safety and efficacy of rTMS is available, further studies are needed to compare ECT and rTMS in terms of the long-term relapse rate and quality of life.

Author Information

From the Research Center for Psychiatry and Behavioral Sciences, and Department of Psychiatry, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran.

Received for publication January 6, 2011; accepted April 18, 2011.

Reprints: Ahmad Ghanizadeh, MD, Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran (e-mail:

The authors have no conflicts of interest or financial disclosures to report.

This study was supported by Shiraz University of Medical Sciences.

This study is registered at the Iranian Registry of Clinical Trials (IRCT138902253930N1).

© 2011 Lippincott Williams & Wilkins, Inc.