A randomized double-blind sham-controlled comparison of unilateral and bilateral repetitive transcranial magnetic stimulation for treatment-resistant major depression
Abstract
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). There are few published reports on the efficacy of sequential bilateral rTMS compared to HFL and sham rTMS. Therefore, this study evaluated the efficacy of HFL and sequential bilateral rTMS compared to sham in TRD. Methods Subjects between the ages of 18 and 85 were recruited from a tertiary care university hospital. Seventy-four subjects with TRD and a 17-item Hamilton Depression Rating Scale (HDRS) greater than 21 were randomized to receive unilateral, bilateral, or sham rTMS. The rates of remission were compared among the three treatment groups. Results The remission rates differed significantly among the three treatment groups using a modified intention to treat analysis that excluded subjects who did not respond to electroconvulsive therapy (ECT) during the current episode. The remission rate was significantly higher in the bilateral group than the sham group. The remission rate in the unilateral group did not differ from either group. Conclusion These findings warrant larger controlled studies that compare the efficacy of sequential bilateral rTMS and HFL rTMS in TRD.
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Prior research has indicated that the sequential bilateral approach involving inhibitory stimulation (1 Hz) to the right DLPFC and excitatory stimulation (10 Hz) to the left DLPFC has exhibited efficacy with standard rTMS and cTBS on the right and iTBS on the left, and has recently demonstrated effectiveness in older individuals.
“Prior research has indicated that the sequential bilateral approach involving inhibitory stimulation (1 Hz) to the right DLPFC and excitatory stimulation (10 Hz) to the left DLPFC has exhibited efficacy with standard rTMS18,19 and continuous theta-burst stimulation (cTBS) on the right and iTBS on the left,20 and has recently demonstrated effectiveness in older individuals.21”
From Can Intermittent Theta-Burst Stimulation of Dorsolateral Prefrontal Cortex Relieve Executive Dysfunction in Patients With Late-Life Depression? (2024) · cites this paper as [18]
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- Authors
- Blumberger, D. M., Mulsant, B. H., Fitzgerald, P. B., Rajji, T. K., Ravindran, A. V., Young, L. T., Levinson, A. J., & Daskalakis, Z. J.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- The Alfred Hospital (AU)
- Corresponding author
- Daskalakis, Zafiris J.
- ORCID
- Venue
- The World Journal of Biological Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2011-07-08
- Volume
- 13
- Issue
- 6
- Pages
- 423-435
- ISSN
- 1562-2975 (ISSN-L)
- 1814-1412
- OpenAlex
- W1969447202
- Cited by
- 118
- References
- 195
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 12 · 2023: 4 · 2022: 13 · 2021: 13 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 11 · 2015: 8 · 2014: 6 · 2013: 8 · 2012: 10
- FWCI
- 4.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The World Journal of Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- Ulster University
- Canadian Institutes of Health Research
- National Health and Medical Research Council
- National Medical Research Council
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- repetitive transcranial magnetic stimulation, high-frequency rTMS, low-frequency rTMS, remission rate
- MeSH terms
- Adult, Aged, Major Depressive Disorder, Double-Blind Method, Female, Humans, Male, Middle Aged, Treatment Outcome, Transcranial Magnetic Stimulation, Depressive Disorder, Treatment-Resistant
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