Sarah Goodwin

Kathi Ovnic
Holly Korschun
May 17, 1999

TREATMENT-RESISTANT DEPRESSION: Results of Latest Electromagnetic Stimulation Study Show Promise

WASHINGTON, D.C. ­ An investigational treatment employing electromagnetic stimulation relieved depression in 25 patients whose depression failed to respond to conventional treatment, report Emory University researchers at this week's American Psychiatric Association meeting.

Scores on depression rating scales administered to study subjects before, during and after the new treatment "were significantly improved at all time points compared to baseline," says first author Yvonne M. Greene, M.D., in the abstract; Dr. Greene is a neurosciences fellow at the Emory University School of Medicine and has collaborated on the open trial with William McDonald, M.D., associate professor of psychiatry and behavioral sciences at the Emory University School of Medicine, and others.

"Sixty-four percent of patients were rated 'very much improved' or 'much improved' on the (CGIC) Clinical Global Impression of Change and 40 percent of patients had an equal to or greater than 50 percent decrease in HDRS (Hamilton Depression Rating Scale) scores at the end of treatment week two. Forty percent of patients were rated 'very much improved' or 'much improved' on the CGIC and 32 percent of patients had an equal to or greater than 50 percent decrease in HDRS scores at the end of the four-week followup.

"These results suggest rTMS (repetitive transcranial magnetic stimulation) may be a viable option for patients with treatment-resistant depression," the authors say.

Prior to receiving rTMS, "There were an average of seven antidepressant failures per patient and eight patients had failed electroconvulsive therapy (ECT)," they say.

"rTMS involves passing current through an electromagnetic coil to generate a magnetic field," they explain.

"The magnetic field acts as the medium between electricity in the coil and induced electrical currents in the brain. The current depolarizes neurons in the brain up to a depth of about two centimeters below the brain's surface. Unlike ECT for depression, rTMS does not require anesthesia or analgesics."

Study subjects were antidepressant-free for one week prior to rTMS and received 10 daily treatments (10 trains of five seconds each, 25 seconds apart) at a frequency of 10 Hz. Seventy-eight percent of patients experienced mild-moderate discomfort at the site of stimulation, two patients who experienced severe pain in the treatment site dropped out of the study and eight percent of patients experienced a posttreatment headache.

The mean age of patients treated was 52 years. " rTMS seems most promising for older adults and for treatment-resistant patients with depression," says Dr. McDonald, who directs the Fuqua Center for Late-Life Depression at Wesley Woods.

Also collarborating on the study were Charles M. Epstein, M.D., associate professor of neurology at Emory; Liquong He, M.D., formerly with Emory; Autumn L. Clark, B.S., study coordinator in Emory's department of psychiatry and behavioral sciences; Fred A. Marstellar, Ph.D., associate professor of psychiatry and behavioral sciences at Emory; and John Woodard, Ph.D., of the Georgia State University Memory Assessment Clinic.

The study was supported by a private grant from the Fuqua Foundation.

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