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Low-Frequency Repetitive Transcranial Magnetic Stimulation Inferior to Electroconvulsive Therapy in Treating Depression

Hansen, Poul Erik Buchholtz MD*; Ravnkilde, Barbara PhD*; Videbech, Poul MD, DMSc*; Clemmensen, Karin MD*; Sturlason, Runa MD*; Reiner, Mads MD*; Parner, Erik MD, DMSc; Rosenberg, Raben MD, DMSc*; Vestergaard, Per MD, DMSc*

doi: 10.1097/YCT.0b013e3181d77645
Original Studies

Objectives: Repetitive transcranial magnetic stimulation (rTMS) is a potential new antidepressant method and alternative to electroconvulsive therapy (ECT). The efficacy of right prefrontal low-frequency rTMS was shown in a previous placebo-controlled, randomized study but has never been compared with ECT. The aim of this study was to compare the antidepressant efficacy and adverse effects of right prefrontal low-frequency rTMS with that of ECT.

Methods: Sixty inpatients with major depression were randomized to 15 days of 1-Hz right prefrontal rTMS or 9 unilateral ECTs. Depressive symptoms and adverse effects were recorded using the Hamilton Scale for Depression and the Udvalg for Kliniske Undersøgelser side effect scale, supplied by neuropsychological assessment of cognitive functions.

Results: Repetitive transcranial magnetic stimulation was significantly less effective than ECT. The intention-to-treat analysis revealed a 26% (confidence interval, 3%-51%) higher rate of partial remission (P = 0.035) by the end of week 3. There was no difference found between the 2 methods on the Udvalg for Kliniske Undersøgelser rating scale. However, psychological examination revealed ECT to have more adverse effects on cognitive functions, whereas the rTMS group improved particularly with respect to visual memory.

Conclusions: Repetitive transcranial magnetic stimulation was significantly less effective than ECT, but ECT had more adverse effects on cognitive function. The outcome does not point to right frontal low-frequency rTMS using the present stimulus design as a first-line substitute for ECT, but rather as a treatment option for patients with depression who are intolerant to other types of treatment or not accepting ECT.

From the *Aarhus University Hospital, Risskov and †Department of Biostatistics, Institute of Public Health, University of Aarhus, Arhus, Denmark.

Received for publication June 17, 2009; accepted January 27, 2010.

Reprints: Poul Erik Buchholtz Hansen, MD, Department N, Aarhus University Hospital, Risskov, Skovagervej 2, 8240 Risskov, Denmark (e-mail:

The study was supported by the Danish Council for Medical Research, the pool to support research in psychiatry, Einar Geert-Jorgensen and wife Ellen Geert-Jorgensen Research Foundation, a Butcher Worzner and wife Inger Worzner grant, the Aarhus University Foundation for Research in Mental Diseases, and the Foundation of Psychiatric Research.

The authors declare no conflicts of interest.

Clinical identifier: NCT00299403.

© 2011 Lippincott Williams & Wilkins, Inc.