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Hemispheric Asymmetry in Resting Motor Threshold in Major Depression

Navarro, Rita MD*; Zarkowski, Paul MD*; Sporn, Alexandra MD; Avery, David MD*

doi: 10.1097/YCT.0b013e3181761cf5
Original Studies

Previous studies of repetitive transcranial magnetic stimulation suggest a hemispheric imbalance in patients with major depression. These studies report an antidepressant effect by activation of the left prefrontal cortex or inhibition of the right prefrontal cortex. The aim of this study is to investigate interhemispheric differences in cortical excitability in a large sample of patients with major depression.

Methods: The resting motor threshold (RMT) was measured on 91 patients with treatment-resistant major depression. We controlled for current medication use, gender, age, handedness, and study site.

Results: There was no significant difference between the left RMT (55.96 [10.356]) and the right (57.74 [11.359]) (P = 0.131, Wilcoxon matched-pairs test). A multivariate analysis found no significant association between depression scores and right or left RMT. After adjusting for important cofactors, benzodiazepine use was found to be a significant predictor of left RMT (P = 0.017, linear regression) and right RMT (P = 0.007, linear regression).

Conclusion: Our results do not support the existence of an interhemispheric imbalance of cortical excitability in depressed patients. Benzodiazepine use was found to raise both the left and right RMT.

From the *University of Washington, Seattle WA; and †Columbia University, New York, NY.

Received for publication January 24, 2008; accepted March 21, 2008.

Reprints: Paul Zarkowski, MD, 325 Ninth Ave, Box 359896, Seattle WA 98104-2499 (e-mail:

The OPT-TMS study is supported by a grant from the NIH.

© 2009 Lippincott Williams & Wilkins, Inc.