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Efficacy of repetitive transcranial magnetic stimulation using a figure-8-coil or an H1-Coil in treatment of major depressive disorder; A randomized clinical trial
Psychiat Hosp Sveti Ivan, Croatia; Josip Juraj Strossmayer Univ Osijek, Croatia; Univ Zagreb, Croatia.
Univ Hosp Ctr Zagreb, Croatia.
Psychiat Hosp Sveti Ivan, Croatia.
Psychiat Hosp Sveti Ivan, Croatia.
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2019 (English)In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 114, p. 113-119Article in journal (Refereed) Published
Abstract [en]

Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment option for major depressive disorder (MDD). However, comparisons of efficacy between the two FDA-approved protocols of rTMS modalities are lacking. The aim of this industry-independent, randomized-controlled, single-blind trial was to evaluate clinical outcome of the two FDA-approved rTMS protocols delivered by H1-coil and the figure-8-coil, in MDD patients. A total of 228 MDD patients were randomized to 20 sessions of H1-coil or 8-coil as an adjunct to standard-of-care pharmacotherapy, or standard-of-care pharmacotherapy alone. Baseline MDD symptom severity was almost the same in the three groups. Hamilton depression rating scale (HAM-D17) mean score was 17 (5.3) in H1-coil, 17 (5.4) in 8-coil, and 19 (6.1) in control group. The primary outcome was the proportion of patients achieving remission defined as HAM-D17 score amp;lt;= 7 at end-of-treatment at week-4. In the intention-to-treat analysis odds ratio for remission was 1.74 (CI95% 0.79-3.83) in H1-coil compared to the 8-coil group. The difference between two rTMS protocols was not significant. Remission rate was significantly greater in both HF-rTMS groups compared to the control: 60% (CI95% 48-71%), 43% (C195% 31-55%) and 11% (CI95% 5-20%) respectively. The response was significantly better in H1-coil, than in 8-coil group OR = 2.33; CI95% 1.04-5.21 (P = 0.040). The HAM-D17 was lowered by 59% in the H1-coil, 41% in the 8-coil (P = 0.048), and 17% in the control group (P amp;lt; 0.001 vs H1-coil; P = 0.003 vs 8-coil). Safety, tolerability, and the changes in quality of life were comparable. We confirmed the safety and efficacy of both FDA-approved protocols as adjunctive treatments of MDD. Better response rate and greater reduction of depression severity were observed in the H1-coil group, but without a significant difference in the remission rate between the two rTMS modalities.

Place, publisher, year, edition, pages
PERGAMON-ELSEVIER SCIENCE LTD , 2019. Vol. 114, p. 113-119
Keywords [en]
Repetitive transcranial magnetic stimulation; rTMS; Deep TMS; Major depressive disorder
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:liu:diva-158831DOI: 10.1016/j.jpsychires.2019.04.020ISI: 000472127300016PubMedID: 31059991OAI: oai:DiVA.org:liu-158831DiVA, id: diva2:1337683
Note

Funding Agencies|Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia

Available from: 2019-07-16 Created: 2019-07-16 Last updated: 2019-07-16

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