A Randomized Double Blind Sham-controlled Comparison of Bilateral and Unilateral Repetitive Transcranial Magnetic Stimulation for Treatment-resistant Major Depression

Objectives: High frequency left-sided (HFL) and low frequency right-sided (LFR) unilateral repetitive transcranial magnetic stimulation (rTMS) are efficacious in treatment-resistant major depression (TRD). Similar benefit has been suggested for sequential bilateral rTMS (LFR then HFL). Therefore, this study evaluated the efficacy of HFL and sequential bilateral rTMS compared to sham in TRD. Methods: Seventy-four subjects between the ages of 18 and 85 with TRD and a 17-item Hamilton Depression Rating Scale (HDRS) greater than 21 were randomized to receive unilateral, bilateral, or sham rTMS. Remission rates were compared among the three groups. Results: Remission rates differed significantly among the three groups. The remission rate was significantly higher in the bilateral group (34.6%) than the unilateral (4.5%) and sham (5.0%) groups. The remission rate in the unilateral group did not differ from sham group. Conclusion: These findings warrant larger controlled studies that compare the efficacy of sequential bilateral rTMS and HFL rTMS in TRD.MAS